Full text of "A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases ... with numerous prescriptions for the medicines recommended ... and an appendix of approved formulae .."

WKS

PlITSByROHACAOE&iyCrfiiELM

322 NORTH CRAIG STREET,
PITTSBURGH, PA.

DICTIONARY

PRACTICAL, MEDICINE:

COMPRISING

GENERAL PATHOLOGY,

THE NATURE AND TREATMENT OF DISEASES, MORBID STRUCTURES,

AND THE DISORDERS ESPECIALLY INCIDENTAL TO CLIMATES, TO THE SEX,

AND TO THE DIFFERENT EPOCHS OF LIFE;

WITH

NUMEROUS PRESCRIPTIONS FOR THE MEDICINES RECOMMENDED

A CLASSIFICATION OF DISEASES ACCORDING TO PATHOLOGICAL PRIN-

CIPLES, A COPIOUS BIBLIOGRAPHY, WITH REFERENCES ;

AND AN

^pptvcniv of ^a^airoijetr jFormulae:

THE WHOLE FORMING A LIBRARY OF PATHOLOGY AND PRACTICAL MEDICINE,

AND A DIGEST OF MEDICAL LITERATURE.

BY JAMES COPLAND, M.D.

Consulting Physician to Qaeen Charlotte's Lying-in Hospital ; Senior Physician to the Royal InSrmarj

for Diseases of Children ; Member of the Royal College of Physicians, London ; Member

of the Medical and Chirurgical Societies of London and Berlin, etc

EDITED, WITH ADDITIONS,

BY CHARLES A. LEE, M.D.

3 s

S ^ 2 VOL. V.

lig NEW-YORK:

~ •^ HARPER & BROTHERS, PUBLISHERS,

82 CLIFF STREET.

184 7.

%..

Entered, according to Act of Congress, in the year 1846, by

Harper & Brothers,
In the Clerk's Office of the Southern District of New York.

CONTENTS.

INSANITY, CONNATE— Definition
, IDIOTIC— Grades of -

Causes, &c.
. PUERPERAL-

-Descrip-

tion, &c.

Pathology — Treatment -
, SUICIDAL— Occasions

6cc.

of,

Causes, Pathology, &c., of

Treatment, &c. ....

Bibliography and References -
INTESTINES— Inflammation of small-
Symptoms, &c.

Inflammation of large

Diagnosis

Terminations of, &c.

Post-mortem Appearances of -

Treatment of, &.c. - - . -

Spasm of

Rupture of

Bibliography and References -
IRRITABILITY— Definitions, &c.

Grades of, &c.

Bibliography and References -
IRRITATION— Pathology and causes of

Treatment of

ITCH— Pathology, Description, &c., of -

Causes — Treatment . - .

Bibliography and References -
KIDNEYS— Diseases of

Inflammation of - - - -

Diagnosis

Consecutive Inflammation of -

Cachectic " " - -

Inflammation of Pelvis, &c.

Organic Lesions of -

Bibliography and References - " -
LACTATION— Disorders of -

Bibliography and References -
LARYNX AND TRACHEA— Nervous
Affections of

Inflammation of - - - -

Treatment

Foreign Bodies in -

Bibliography and References -
LEPROSY— Description, <kc., of -

Bibliography and References -
LEUCORRHCE A — Vaginal, Description
of, &c.

Uterine

Treatment

Bibliography and References -
LICHENOUS RASHES— Description of
LIVER— Causes of its Diseases

Functional Disorders of -

Congestions of - - . .

Haemorrhage of - - - -

Inflammation of - - - -

Diagnosis, &c. - - . .

Prognosis — Treatment ...

Structural Changes in - - -

Treatment, &c. - - . .

Bibliography and References -
LUNGS— Diseases of - - -- -

Acute Pneumonia - - - -

Inflammation of - - - -

Diagnosis

Complications

Causes and Treatment -

625
626
627

628
633

636
648
652
655

659
665
671
673
675
679
684
687
689
691
693
696
697
710
716
718
721
721
722
728
731
736
757
765
771
773
776

776
787
799
803
807
808
815

816
820
824
826
827
829
834
839
843
844
852
854
866
875
877
878
879
880
883
887
890

Chronic Inflammation, &c., of-

Emphysema of the - - - -

Abscesses perforating the

Gangrene of

Bibliography and References -
LUPUS— Definition, &c., of -

with Hypertrophy — Diagnosis -

Treatment

LYMPHATIC SYSTEM— Inflammation,
&c., of

Alterations of Structure - - -
GLANDS — Inflammation

Pig*
901
902
907
909
912
913
915
917

919
921

- 923

Structural Changes of - - - 925

Treatment — Bibliography, &c. - 928

MAMMA— Diseases of the - - - 928

Functional Affections of - - - 929

Organic Lesions of the - - - 933

Bibliography and References - - 938

MEASLES— History and Description - 939

Terminations — fatal Signs - - 944

Diagnosis, Causes, &c. - - - 946

Treatment, &.c. .... 949

Bibliography, and References - - 951

MEDIASTINUM— Causes and Treatment 952

MEL.ENA— Causes and Treatment - 953

M E L A N S I S— Forms, Causes, and

Cure -'- 956

MENSTRUATION— Phenomena of - 959
, DELAYED— Diag-
nosis 963

Treatment 965

, OBSTRUCTED - 967

, SUPPRESSED - 969

Complicated Amcnorrhcea - - 971
, DIFFICULT— De-
scription, (Sec. 973

■ , EXCESSIVE— Men-
orrhagia 977

Treatment, &c. - - - - 979

Bibliography and References - - 982

MESENTERY— Diseases of the Glands of 983

Prognosis and Treatment - - 989

Bibliography and References - - 992

MILIARY ERUPTION— Definition, &c. 992

MUSCULAR STRUCTURE — Diseases

of, &c. 993

Treatment and Bibliography - - 998

NERVES— Structural Changes of - - 999

Inflammation of - - - - 1002

Treatment — Bibliography, &c. - 1005

NEURALGIC

Of the Extremities, &c. -
Causes and Cure

AFFECTIONS— Notices
1006

- 1011

- 1015

Bibliography and References - - 1028
NIGHT BLINDNESS— Pathology-
Treatment, &c. 1031

NOSTALGIA— .Etiology, &c. - - 1033
OBESITY— Definition of— Characters - 1035
Pathology and Treatment - - 1038
(EDEMA— Definition— Treatment - - 1039
CESOPHAGUS— Structural Changes-
Diseases 1041

Ulceration, &c - . - . 1047

Treatment— Bibliography, <kc. - 1052
OSSEOUS SYSTEM— Inflammation of

the Bones 1054

Necrosis, dec. - - - - - 1055

\c<b'^.'25<b

CONTENTS

THE SECOND VOLUME.

Page
GALL-BLADDER AND DUCTS .... 6

GANGRENE 9

GASTRO-ENTERIC DISEASE i29

GLANDERS 34

GOUT 87

HEMORRHAGE— Pathology' of .... 72

FROM THE SKIN ... 87

NOSE ... 88

MOUTH AND THE

THROAT 94

RESPIRATORY OR-
GANS 95

STOMACH . . 108

INTESTINES. .118

• URINARY ORGANS 122

UTERUS . . .127

INTO SEROUS CAVITIES . . 142

THE AREOLAR TISSUE

AND SUBSTANCE OF ORGANS . . .143

HEMORRHOIDS 144

HAIR 150

TRICHOMATOUS— PLICA . . . .164

HEADACHE 167

HEARING 182

HEART AND PERICARDIUM-Diseases of the . 193

HERPETIC ERUPTIONS 267

HICCOUGH 271

HOOPING-COUGH 273

HYDATIDS . 292

HYPERTROPHY 298

HYPOCHONDRIASIS 300

HYSTERIC AFFECTIONS 314

JAUNDICE 341

ICHTHYOSIS 360

LMPETIGINOUS AFFECTIONS . . . .363
IMPOTENCE AND STERILITY . . . .369

IN THE MALE 370

AND STERILITY IN THE FEMALE 373

INDIGESTION 377

INDURATION 400

INFECTION 401

INFLAMMATION 426

INFLUENZA 489

INSANITY 500

, IDIOTIC 625

Page
INSANITY, PUERPERAL 628

, SUICIDAL .' 636

INTESTINES— Diseases of, etc 658

IRRITABILITY 690

IRRITATION 696

ITCH 716

KIDNEYS— Diseases of, etc 721

LACTATION— Disorders of 772

LARYNX AND TRACHEA 776

LEPROSY 607

LEUCORRH(EA 816

LICHEN 826

LIVER— Diseases of, etc 829

LUNGS— Diseases of, etc 878

LUPUS 913

LYMPHATIC AND LACTEAL SYSTEM — Dis-
eases of 918

LYMPHATIC GLANDS 923

MAMMA 928

MEASLES 938

MEDIASTINUM 951

MELENA 953

MELANOSIS 955

MEMBRANES 959

MENSES 1

MENSTRUATION i Phenomena of . . . .959

, DELAYED . . . .963

, OBSTRUCTED . . .966

, SUPPRESSED . . .968

, DIFFICULT . . . ,972

, EXCESSIVE . . . .976

MESENTERY 983

MH.IARY ERUPTIONS 992

MUSCULAR STRUCTURE— Diseases of . . 993

NERVES 998

NEURALGIC AFFECTIONS 1006

NIGHT-BLINDNESS, ETC 1029

NOSTALGIA 1033

OBESITY 1035

CEDEMA 1039

CESOPHAGUS 1041

OSSEOUS SYSTEM 1053

OVARIA 1061

OZENA 1067

APPENDIX OF FORMULiE.

In order to prevent repetitions, and to facilitate references, the following collection of For-
mulae is here appended and arranged in alphabetical order, in addition to those which it was
necessary to give in the body of the work. The author has not added any of the formulae pre-
scribed by the three British Colleges of Physicians, as they are already in the hands of every
practitioner. The preparations and recipes he has given, both here and at other places, consist
of a careful selection of those which are most approved, contained in the Pharmacopceias of va-
rious hospitals and foreign countries, and from the writings of a number of eminent practical
physicians, as well as of those which he has been led chieliy to confide in during a practice of
upward of twenty years. He has followed the Nomenclature adopted by the London College
in the latest edition of their Pharmacopoeia ; and to avoid circumlocution, he has retained the
short and characteristic names usually employed, although many of them are by no means
classical.

Form. 1. AcETUM Antihystericum. (Disp. Fuld.)
R Castorei, Asafetidae, 55, Jij. ; Galbani, yss. ; Herbne
Ruta; receulis, 5J. ; Aceti Vini, Ibij. Macera bene et
cola.

Form. 2. Acetum Camphoratum.
R CainphoraD Pulver. cum Alcoholis pauxillo solutai, fss. ;
Sacchari Albi, fijss. ; Aceti Vini, f vss. Solve. (5j. con-
tains 3S6. of camphor).

Form. 3. Acetum Camphor.^: et AMiwoNiiE.
R Camphorac, 3ij-, teratnr in mortario vitreo, cum Alco-
holis guttis, XX. vel XXX. ; Sacchari Albi, fss., iritis
adde, Acidi Acetici Fortioris, Jij.; Liquoris Ammoniie
Acetatis, jiijss. ; lufusi Cinchome, vel Aquse Destillatie,
5iijss. Fiat Mist., cujus sumat eeger Cochlear., ij.,
ampla secunda vel tertia vel quartu quaque hor4. (In
the last stag^e of Febrile Diseases attended with de-
pressed powers of life.)

Form. 4. Acidum Nitro-Hydrochloricum.
R Acidi Nitrici, Acidi Hydrochlorici, singulorum partes
(inensurit) lequales. Dosis i minim., vj. ad Tltxx., bis,
ter, siepiusve quotidie, m Hordei Decocti, 51V., cum
Sirupo Simplicc.

Form. 5. Acidum Nitro-Hydrochloricum Dilutum.

R Acidi Nitro-llydrochlorici, Aquse Destillatae, 55, Oj.
Misce. (The nitro-hydrochloric acid bath may consist
of three ounces of this diluted acid to every gallon of
water.)

Form. 6. ^ther Phosphoratus.
R Phosphori Puri, gr. ij. ; Olei Mentha Piper., 3j.-3ss.
Solve, et adde iEther. Sulphur., 5J. M. Vel,

Form. 7.
R Phosphori Puri, gr. ij. ; jEther. Sulph., fjss. ; Olei Va-
lerianae, Hlxij. M. (In doses of vj. to lij. drops on
sugar.)

Form. 8. Aqua Cosmetica.
R Mist. Amygdal. Amar. vel Dili, colatae, f iij. ; Aquae Rosae
et Aquie Flur. Aurantii, 55, jiv. ; Sodse Biboratis, 3j. ;
Tinct. Benzoini comp., 31J. M. Fiat Lotio.

Form. 9. Aqua Styptica.

R Ferri Sulphatis, Aluminie Sulphatis, 55, 5Jss. ; Aquae,

5xij. Solve et cola ; dein adde Acidi Sulpiiurici, fj.

Form. 10. Aqua Styptica Cupri et Zinci.

R Zinci Sulphatis, Cupri Sulphatis, 58, 3j. ; Aquae Rosae,

fviij. Solve.

Form. 11. Aqua Styptica Zinci.
R Zinci Sulphatis, Aluminae Sulphat. Calcin., 55, 3j. ;

Aqua- Rosa;, ^vj. Solve.

Form. 12. Aqua Traumatica Thedenii.
R Acidi Acetici, Ibiij. ; Alcoholis, ftij. ; Acid. Sulphur.,
Ibss. ; Mellis Despuniati, tbj. Misce,

Form. 13. Aqua Vanii.l*.
R Frucl. Vanillae concis. et cont.jjvj.; Potasss Carbon.,

3vj. ; Aquae Destil., Oij. ; Spirit. Vini Ten., Ojss. Ma-
cera leni cum calore per triduum, et cola.

Form. 14. Balneum Ioduretum. (Lugol.)
R Solut. lodinse Rubefac. (Vide Form, inter Solutiones),
5j.-5iv. ; Aquie Cong., xj.-l.

Form. 15. Balneum Sulphureum.
R Magnesia Sulphatis, 3iv. ; Potass* Bitart., 3j. ; Potassii
Sulphureti, 3j. : tere simul, et solve in Singulis Congiis
AqUie Balnei.

Form. 16. Balneum Potassii Sulphureti.
R Potassii Sulphureti, ?j. ad f iv. ; Aquae Communis, Ibc.
ad Ibcc. Solve. (Nearly the same as the sulphureous
baths of Bareges. In Chronic Affections of the Skin,
and in Chronic Visceral Affections.)

Form. 17. Balneum Potassii Sulphureti et Gela-
tine.

R Potassii Sulphureti, ^ij. ad f iv. ; Aquae Communis, Ibc.
ad Ibcc. Solve, et adde IchthyooolliE, Ibj. ad Ibij., in
Aquae bullientis solutte, Ibx. (i)uPUYTREN.)

Form. 18. Balsamum Astringens.
R Olei Terebinthinae part., ij. ; adde guttatim Acidi Sul-
phurici, part, ijss., in vase vitreo, o\>e balnei arenarii
calefacto. Liquori refrigerato, adde gradatim Alco-
holis, part. viij. Macera per dies septem. (Dosis
3SS.-3J. vehiculo quovis, idoneo, in Morbis Hiemurrha-
gicis.)

Form. 19. Balsamum Astringens.
ft Olei Terebinthinae, Aridi Hydrochlorici Concent., S3,
part. j. ; agita bene, et post diem adde Alcoholis, part,
viij. ; Camphoric, part. ss.

Form. 20. Balsamum Succinatum.
R Balsami Copaibie, Terebinthinae Venet., Olei Snccini,
33. 3j. Misce. Capiat lllxxx. ter quotidie in quovis
vehiculo idoneo. (In Leucorrhoea, Gleet, Emissions,
&c.)

Form. 21. Balsamum Sulphukis, vel Oleum Sul-

PHURIS.

R Florum Sulphiiris, partem j. ; Olei Amygdal. Dulc, part.
iij.; Olei Anisi, part, ij, Macera per dies septem in
balneo araiiario.

Form. 22. Balsamum Sulphubis Terebinthinatum.
(liahamum Vita Rulandi.)

ft Florum Sulphuris, part. iij. ; Olei Lini, part. vij. ; Olei
Anisi, part. v. Solve in balneo arenario, et adde Olei
Terebinthina>, part. xx. Misce. (Excitant, diuretic,
expectorant, &c. Dose ttlx.-xxx.)

Form. 23. Balsamum Terebinthinatum.
ft Olei OlivE, f vj. ; Terebinthinff-, fij. ; Cera Flava, f j. ;
Bala. Peruvian., 3ij. ; Camphora rasa-, "jss. Solve
Oleum, Terebinth., et Ccram ; dein adde alia. (Near-
ly the same as the Balsam of Chiron, a long- celebrated
medicine,)

APPENDIX OF FORMULAE— Bolus— Decoctum.

Form. 24. Bolus Anodynus.
R Pulv. Jacobi veri, gr. iv. ; CamphoriH Pulverizat., gr. iij. ;
Pulv. PotassiE Nitratis, gr. x. ; Extract! Hyoscyami,
gr. vij. ; Conservie Rosar., q- s., ut fiat Bolus, H. s. s.
(la Cerebral Affections, &c.)

Form. 25. Bolus Ante Spasmos.
B; Pulveris Castorei Optimi, Jij. ; Pulv. Radicis Valeriana,
fss. ; Camphora; rasa;, 3j. Misce accurate, et adde
Sirupi Papaveris satis quantum ut fiant Boli granorum
duodecim : iuvolvantur pulvere Stigmalorum Croci
Sativi.

Form. 26. Bolus Arnice.
R Pulv. Flor. Arnicae Montaii., Camphors rasae, aa, gr. iv. ;
Conservaj Rosar., q. s., ut fiat Bolus.

Form. 27. Bolus Bismuthi Compositus.
K Moschi, gr. x. ; Bismuthi Trisnitratis, gr. iij.-viij. ; Opii
Puri, gr. ss.-j. ; Conserve Rosar., q. s., ut fiat Bolus,
pro re nati sumeiidus.

Forni. 28. Bolus Cambogi^.
R Cambogiffi Gummi Resinae, gr. viij. : tere cum Olei Ju-
niperi, Tlliij., et adde Potassas Bitart., gr. xx. ; Pulv.
Scillffi, gr. j. ; Sir. Zingiberis, q. s., ut fiat Bolus.

Form. 29. Bolus CamphorjE.
R CarapliorE ras« et ope Alcoholis subactae, gr. iij.-x. ;
Pulv. Flor. ArniciE Montanae, gr. lij.-vj. ; Confect. Ros<e
Caninae, q. s., ut fiat Bolus, quarta vel sexta quaque
hora sumendus.

Form. 30. Bolus Catechu Thebaiacus.
R Catechu Ext. contriti, gr. xv. ; Coufectionis Opii, gr.
viij. ; Pulv. Cretie, gr. iv. ; Sirupi Aurantii, q. s., ut
fiat Bolus, bis, ter, seepiusve in die deglutiendus.

Form. 31. Bolus Ferbi.
R Ferri Sesquioxidi, gr. x.-xx. ; Pulv. Aromatici, gr. v. ;
Sirupi Zingiberis, q. s.,ut fiat Bolus, bis terve quotidie
deglutiendus.

Form. 32. Bolus Guaiaci Ammoniati.
R Guaiaci Gum. Resinae, gr. viij.-xij. ; Camphnrae rass,
Ammoniae Sesquicarbon., aa, gr. iv. ; Pulv. Acaciae, gr.
iij. ; Confect. Rosa;, q. s., ut fiat Bolus, hor4 somni su-
mendus.

Form. 33. Bolus Guaiaci Compositus.
R Guaiaci Resin, cont., 3j. ; Ipecacuanha Rad. Pulv., gr.
j. ; Opii Puri, gr. j. ; Confectionis Rosae CaniniE, q. s.,
ut fiat Bolus, semel, bis, terve quotidie capieudus.

Form. 34. Bolus Kino Thebaiacus.
R Pulv. Kino Compos., gr. v.-x. ; Pulv. Crets Compositi,
gr. XV. ; Pulv, Opii, gr. ss. ; .Sir. Zingib., q. s., ut fiat
Bolus, bis, ter, saspiusve in die sumendus.

Form. 35. Bolus Moschi Compositus.
R Moschi, gr. xxiv. ; Pulv. Rad. Valerianae, 3ij. ; Cam-
phorae rasa, gr. xx. ; Conservae Rosar., q. s., ut fiant
Boll, iv. Capiat unam 4ta quiique hora.

Form. 36. BoLUS Nitro-camphoratus cum Opio.
R Camphora rasae, gr. iij.-vij. ; Potassa; Nitratis, gr. x.-xy. ;
Opii Puri, gr. ss.-jss ; Conservai Rosar., q. s., ut fiat
Bolus, hora somni sumendus.

Form. 37. BoLus Rhei Compositus.
R Rhei Pulv., gr. x.-xv. ; Pulv. Cretae Comp., gr. vij. ; Pulv.
IpecacuanhiB Cuiiip., gr. lij.-vij. ; Sirupi Zingiberis, q.
s., ul fiat Bulus, hor4 somni sumendus.

Form. 3S. BoLus Sedativus.
R Acidi Boracici, 3j.-3ss. ; Conserv. Rosar. et Sirupi, q.
s., ut fiat Bolus, pro re natd sumendus.

Form. 39. Bolus Sudorem Ciens.
R Camphorae rasae, gr. j.-iij.; Potassa Nitratis, gr. xij. ;
Pulv. Ipecacuanhae, et Pulv. Opii Puri, aa, gr. j. ;
Sirup. Zingib., q. s., ut fiat Bolus.

Form. 40. Bolus Valerian* cum Ferro.
R Ferri Sesquioxidi, gr. v.-3j. ; Pulv. Valerianae, 3ss. ;
Sirupi Zingib., q. s. Fiat Bolus.

Form. 41. Cataplasma Ioduretum.
R Cataplasm. Faiinae Semin. Lini tepid., q. s. ; Solut. lo-
dina Rubef., q. s. Sit Cataplasma.

Form. 42. Cataplasma Sinapeos Fortius.
R Pulv. Sinapeos, ibss. ; Pulv. Capsici Annul, Pulv. Zin-

giberis, 5a, 3j. ; Acidi Acetici Pyrolignei, q. s., ut fiat
Cataplasma ; dein adde Olei Terebinthina, 51J. Misce.

Form. 43. Cataplasma Sinapeos Mitius.
R Cataplasmatis Lini, part. ij. ; Farina Sinapeos, pars j. M.

Form. 44. Confectio Mentha Viridis.
R Mentha Viridis Fol. recent., '^iv. ; Sacchari Purifirati,
^xij. Folia in mortario lapideo contunde : turn, adjec-
to Saccharo, iterum contunde, donee corpus sit unum.
(Sprague.)
Form. 45. Confectio Seuvje Composita.
R Sulphuris Sublimati, Potassa Sulphatis, aa, fss. ; Con-
fectionis Senna, fij. ; Sirupi Aurantii, q. s. Capiat,
3j~3'j) Pf" dose.

Form. 46. Conserva Acetosell^.,
R Fol. Acetosella, ^iv. ; Sacchari Purificati, 5*ij- Con-
tunde probe simul, et fiat Conserva.

Form. 47. Decoctum AlthjE^.
R Althaa Radicis exsiccata incis., f ij. ; Rad. Glycyrrhiza
contus., 3iij. ; Aqua Destillatae, Ojss. Coque leni igne
ad Oj., et cola.

Form. 48. Decoctum Arctii LAPPiE.
R Rad. Arctii Lappa, 5Jss.-fij. ; Aqua, fxvj. Coque ad
fxij., et cola.

Form. 49. Decoctum Arctii Lapp* Compos.
R Rad. Arctii Lap. recent., fij. ; Lign. Sassafras, Dulca-
mara, aa, 3!ij. ; Rad. Glycyrrh., 3jss. ; Aqua, Ojss.
Coque ad Oj., et exprime.

Form. 50. Decoctum et Infusum Beccabung*.
R Herba Veronica Beccabunga recentis, fiij. ; Aqua Fer-
ventis,Oj. Macera per horas binas, vel coque perquar-
tam hora partem, et exprime. Capiat jij. ter quaterve
quotidie ; vel utatur externe pro embrocatione, super
Ulcerationes Struraosas applicata.

Form. 51. Decoctum Calumb* Comp.
R Rad. Calumba, Lign. Quassia ras., aa, 3ij.» Corticis
Aurantii exsic, 3j. ; Rhei Pulv., 3j. ; Potassa Carb.,
3j. ; Aqua, fxx. Coque ad fxv., et cola; dein addo
Tinct. Lavandul. Comp., 5j. (Niemann.)

Form. 52. Decoctum Cacuminum Pini Compositum.
R Cacum. Pini Sylvest., fij. ; Radicis Symphyti Majoris,
?j. ; Aqua, ttij. Coque per hora partem quartam ;
exprime, et cola.

Form. 53. Decoctum Cinchon/E Aperiens.
R Corticis Cinchona Pulv., 5J. ; Aqua, Ibij. Coque per
partem hora quartam, et adjice Fol. Senna, Jss. ; Rad.
Zingiberis cont., 3j. ; Soda Sulphatis, fss. ; Hydroehlor.
Ammonia, 3j. Macera per horas binas, et adde Tinct.
Senna Comp., §j. M.

Form. 54. Decoctum Cinchon* Compositum
R Cinchona Lancifol. Cort. contus., fss. Coque ex Aquae
Pura, fxvj., ad consumpt. diniid., adjectis sub finem
coctionis Serpentaria Radicis contusa, 3ij. Stent per
horam, et cola ; dein adde Spirit. Cinnamom. Comp.,
fjss. ; Acidi Sulphur, dilut., 3jss. M. Sumantur f ij.,
sexta quaque hori.

Form. 55. Decoctum Cinchon* et Rhei.

R Corticis Cinchona Oblongifol. contusa, 3i)j. ; Radicis
Gentiana incisa, 3ss. ; Radicis Rhei Palmati, 3ijss. ;
Carbonatis Potassa, 3j.; Aqua Fontana, s. q. Coque
per horam unam ut obtineantur colatura uncia duode-
cim, et cola.

R Liquoris Colati, f vss. ; Tinctura Canella, Spirit. Anisi,
la, 3jss. ; Sirupi Aurantii, fss. M. Capiat Cochlear
j. vel ij. amjxla.

Form. 56. Decoctum Cinchon* et Serpentaria.
R Cort. Cinchona pulveriz., 3vj. ; Rad. Serpentaria, fss. ;
Corticis Aurantii sic, 51J. ; Aqua, ttijss. Coque adlbj.,
et adde liq. colato, Tinct. Cinnamom., f j.

Form. 57. Decoctum Cydoni* Comp.
R Semin. Cydon. contus., 3ij. ; Rad. Glycyrrh. contus.,
Fici Cario;e Fruct., 55, f j. ; Aqua Bui., Oj. Coque
cum igne leni per partem hora quartam, deindc cola.

R IIujus Decocti, fvjss. ; Bi-boratis Soda, 3j. ; PotasssB
Tart., 3ij. ; Spirit. JEthcr. Nit., 3ij. ; Sirlipi Mori vel
Sue. Inspiss. Samb. Nig., fss. M. Fiat Mist., cujus
Capt. Cochlearia, ij . larga, secundis vel tertiis horis.
(In the irritative Inflainmntion of the Mucous Surface
of tho Digestive Organs, Dropsy, &c.)

" -I li.L-Jo/ilt

APPENDIX OF FORMUL-E— Decocto

322 NORTH CRAIG STREET

Vll

Form. 58. Decoctum Deobstruens.
R Radicis Taraxaci, Herba; FumariiE, Fol. Sisymbrii Nas-
turt., Ful. Chterophylli Sylvest.,aa, fj. Omnibus bene
concisis, adde Seri Lactis, fxxxij. Coque per minuta
horiE, vj. ; et posteam acera ad rcfrigerationeni ; dein
cSla. ColaturiE adde Soda; Potassio-Tartrat., 5ss.-3vj. ;
Mellis Optimi, 5J. M. Capiat Cyathos Vin. ij., vel
iij., veJ iv., iu die. (Van Svvieten.)

Form. 59. Decoctum Depurans.
R Caul. Dulcamarm, Ilcrbse FumariiB OfTicin., Cort. Ulmi
contusi, Had. Arctii Lappie cone., Rad. Rumicis Pa-
tientiae concis., 53, fss. ; Aquie Font., tbijss. Coque ad
Ojss., et cola. Liq. colato adde Sirupi Sarzae, fij. M.
Capiat 5J.-3JSS., ter quaterve quotidi^.

Form. 60. Decoctum Dulcamara
R Stipitum Dulcamarae, 5J. ; Corticis Aurantii, 3ij. ; Aqus
tbjss. Coque ad tbj ', et cola.

Form. 61. Decoctum DuLCAMARiG Comp.
R Caul. Dulcamarse, Radicis Arctii Lappae, 53, 3vj. ; Ra-
dicis Glycyrrh., Lign. Sassafras ras., Lign. Guaiaci ras.,
55, 3ij.; AquiE Font., tbij. Coque a<l colatur<e, ?xx.
{AuousTiN, Rheumatism, Syphilis, Cutaneous Affec-
tions, &c.)

Form. 62. Decootum Filicis Compositum.

R Radicis Filicis Maris, f j. ; Rad. Inulte Helenii, 3ij. ; Fo-
lior. Absinthii, jss. ; Seminum Santonicse cont., 3iij. ;
Aquff, Ojss. Coque ad Oj., et cola. Liq. colato adde
Sirupi Rhamni, 5J. M.

Form. 63. Decoctum Gai.l*.

R Gallarum contusarum, jss. ; Aquae Destillatae, Oijss.
Decoque ad oct. ij., et liquorem cola. Turn adde Tinc-
tursE Gall*, 5J. (This decoction, used as a fomenta-
tion, enema, or injection, is of considerable use in the
treatment of Prolapsus Ani, Ilffimorrhoids, and in Leu-
corrhoia.)

Form. 64. Decoctum Gentian* Comp.

R Radicis Gentianae Luteae incisae, fss. ; Aqus FontaniE,
Ibij. Coque per seniihoram, deinde infunde quantum
sufficit super Radicis Calami Arom., 3'ij. '■ cola, et post
refrigerationem adde jElheris Sulph., 3ij. ; Sirupi Au-
rantii, fss. Misce.

Form. 65. Decoctum Guaiaci et DulcamaR/E Comp.

R Rasur. Lipni Guaiaci, 5Jss. ; Stipit. Dulcamaras, jjss. ;
Rad. Lauri Sassafras concis., Flor. Amicae, Rad. Cal.a-
mi Arom., Rad. Glycyrrh., aa, Jss. ; Semin. Fceniculi,
3ij.; Aquie, Ibiij. CiKjue ad Ibij., et cola. Capiat
f j.-fiij., ter quarterve quotidie.

Form. 66. Decoctum Helenii Comp
R Rad. Inulae Helenii, f j. ; Summit. Hyssopi Officin., jiij. ;
Fol. Heder- Terrest., 3ij. ; Aquae, q. s., ut sint Colaturx,
fxij. Coque per partem hotie quartam, et cola : adde
liq. colato, Potassae Carbon., Jj. ; Sirupi Tolutaiii, Si-
rupi Althaae, 55. jj. M. Capiat 5J.-5ij., ter quaterve
quotidie. (In Chronic Catarrhs, the Pectoral Affec-
tions of Debility, Asthma, Chlorosis, Amenorrhcea, &c.)

Form. 67. Decoctum Inul/B Compositum.
R Rad. Inulae Helen., Jjss. ; Hyssopi Officinalis, Flor. Tilite
Europaeae, aa, 3iij. ; Fol. Heder. Tenest., 3ij. ; Aquae,
Ibij. Coque ad tbjss. ; exprime, et cola. Colatura;
adde Spirit. jEther. Nit., Jss. ; Potassae Nitratis, 3j. ;
Sirupi Scillae, 3ij. ; Sirupi Althaeae, fss. M.

Form. 68. Decoctum Pectorale Elsneri,
Rad. Glycyrrh., Croci Stig., Rad. Inulae Heleni

Rad.

Iridis Flor., Semin. Anisi, Hyssopi Officin., 5a,
Aquae, H)ij. Coque ad tbjss. ; cola, et adde Tinct. IJals.
Tolutaiii, 5j. ; Sirupi Tolutani, fj. ; Mellis, jj. M.
Capiat 5J.-5ij.,4tis vel 6tis horis.

Form. 69. Decoctum PuniCjE Grakati.
R Corticis Radicis Punicae Granati recent, et exsic, JiJ. ;
AquiE Com., Oij. Maccra sine calore per horas, xxiv. ;
dein cocjue ad Oj., et cola. (The whole to be taken in
three doses within two hours.)

Form. 70. Decoctum Quassia Comp.
R Li?ni Quassiae rasi, f ss. ; Flor. Anthemid., Jvj. ; Potassae
Carbon., 3ijss. ; Aq. FoDtau., Ibij. Coque ad dimidium,
et cola.

Form. 71. Decoctum Santonici.

R Santonici Semin. contus., jij. ; Aquae Destillata;, 5x1.

Coque lento igne ad Oj., et cola. (In Ascarides.)

Form. 72. Decoctum SarzjE Compositum.
R Sarzae Radicis, concisT! et contusae, 5jss. ; Glycyrrhizae
Radicis contusae, 5ss. ; Coriandri Seminum contus., 3ij. ;

Liquoris Potaisse, 3j. (vel sine) ; Aquae Ferventis, Oj.
Macera per horas, xxiv., in vase leviter clauso, ct
cola: liquoris colati suinat partem 3tiam ter quolidi^.
(Sprague.)

Form. 73. Decoctum Secalis Cornuti
R Secalis Cornuti, 3ij. ; Aquse, Jvij. Decoque od fiv. Ab
igne remove, et jiaulo post e fsecibus effunde.

Form. 74. Decoctum SENEGiE.
R SenegiE Radicis cont., 3vj. ; Aqua:, Oij. Coque ad Oj. ;
et sub linem coctiiinis adde Glycyrrh. Rad. contusa:,
fss. Exprime, et cola.

Form. 75. Decoctum Scoparii Cacuminum.
ft Scoparii Cacuminum concisi, 5J. ; Aqua; DestillatE, Oj.
Decoque ad octarium dimidium, et cola.

Form. 76. Decoctum Taraxacj Comp.
ft Radicis Taraxaci, ?iv. ; Bitart. Potassae, Bi-bnratis Sodae,
55, Jss. ; Aq., tbiij. Coque ad tbij. ; et adde, ut sit oc-
casio, vel Spirit, ^ther. Nit., vel Tinct. Scilla-, vel
Spirit. Juniperi Comp., vel Oxymel Scilla;.

Form. 77. Decoctum Taraxaci Comp. Stollii.
ft Rad. Taraxaci, Rad. Tritiri Rep., 55, jij. ; Aq , Ibiij.
Coque ad Ibij. : cola, et adde colatura;, Potassae Sulph.,
5ss. ; Oxymel, 5J. M. (In Visceral Obstructions.)

Form. 78. Decoctum Tormentill*.
ft Tormentillae Radicis contnss, 5j. ; Aquae Destillatffi, Ojss.
Coque ad octarium, et cola.

Form. 79. Electuarium Alkalino-ferratum.
ft Sesquioxidi Ferri, fss. ; Potassae Carbonatis, 3j. ; Car-
bonat. Calcis, 3ij. ; Pulv. Zingiberis, 3jss. ; Sirupi Au-
rantii, fiijss. M. Fiat Elect, cujus capiat Coch., j.,
minim, mane nocteque. (Chlorosis, Chorea, &c.)

Form. 80. Electuarium Anthelminticum.
ft Pulv. Valerianae, Semin. Santonicae contus., aa, ?ss. ;
Potassae Sulphatis, 311). ; Pulv. Jalap., 3iv. ; Oxymel.
Scillae, Jiv. ; Pulv. Glycyrrh. (vel Extr. Glycyrrh.),
fij. M. ut fiat Electuarium. (For children, one to
two drachms ; and for adults, f ss., three or four times
daily.)

Form. 81. Electuarium Antispasmodicum.
ft Pulv. Cinchona;, 5J. ; Pulv. Valerianae, f ss. ; Confect.
Rutae, f j. ; Confect. Ros. Gall., js.s. ; Confect. Aurantii,
3iij. ; Olei Cajeputi, 3ss, ; Sirupi Aurantii, Jijss. ; vel
q. s., ut fiat Electuarium moUe. Capiat 3j.-3iij., mane
nocteque. (In Epilepsy, Chorea, Hysteria, Flatulen-
cy, &c.)

Form. 82. Electuarium Aperiens.
ft Magnesiae, Potassae Bitart., Flor. Sulphuris, Pulv. Rad.
Rhei, Pulv. Flor. Anthemidis, 55, gr. vj. ; Sirupi Au-
rantii, 3iij. ; Olei PimentiE, tlUj. M. Sit Electuariifln
pro dose. (Hecker.)

Form. S3. Electuarium Aperiens.
ft Manns, 3vj. ; Sirupi Sennae, 3iij. ; Olei Aniygdal. Dulc,
3ij. Tere bene, et adde Aquae Fceniculi, 31J. ; Sacchari
Albi, 3jss. Sit Electuarium, cujus capiat infans,3j.-3ij.,
pro dose.

Form. 84. Electuarium Arnic^k Composit.
ft Pulv. Flor. Arnicae, jiij. ; Pulv. Cinchona;, Jss. ; Pulv.
Rad. Scrpenlariae, jiij.; Confect. Aromat.,'3j. ; Sirupi
Aurantii, Jiij. Misce. Capiat 3j.-3ij., 2 dis horis.

Form. 85. Electuarium Bechicum.
ft Mannae Optims, 5j. ; tere oum Aq. Flor. Aurantii, q. s.,
ct adde gradatim Pulv. Acaciae, Jss. ; Extr. Glycyrrh.,
3j. ; Sirupi Tolutani, q. s. Sit Electuarium molle, cu-
jus capiat pauxillum urgent! Tusse. Interdum adde
Pulv. Ipecacuanhoe, Extract. Conii, vel Extr. Lactucie.

Form. 86. Electuarium Cinchon.e Aperie.ns.
ft Ciuchonae Lancifol. Cort. in Pulv., ^j. ; Valeriana; Rad.
Pulv., 3iij. ; Confectionis Sennae, fjss. ; Confect. Aro-
mat., 3ij. (vel Confect. Piperis Nigri, 3iij.) ; Sirupi
Sennae, gijss., vel q. s., ut fiat Electuarium molle, cu-
jus devoret Cochlear., j.,vel ij., minima mane, meridie,
ct nocte. (In Ague, Diseases of Debility, &c.)

Form. 87. Electuarium Cinchona Compositum.
ft Cinchona; Cordif. Corticis Pulv., 5j. ; Confectionis Rdsss
Gallicae, ?ss. ; Acidi Sulphurici diluti, 3j. ; Sirupr Zin-
giberis, 5jss. M. Fiat Electuarium. Dosis 3j.-3ij ,
ter quaterve in die.

Form. 88. Electuarium Cinchon.'e dum Ferro.
ft Cinchonae Cort. Pulv., Wj. ; Ferri Sesquioxidi, 3ij.-3ij. :

APPENDIX OF FORMULAE. — Electuarium — Emplastrum.

Sirup. Zingiberis, q. s., ut fiat Electuarium. Dosis
3j-3'.i-i l^'s terve quolidie.

Form. 89. Electuarium Deobstruens.
R Potass* Bitart.. ^jss. ; Si.lph. I'rifcip., fj. ; Sodoe Bibo-
ratis, 31JSS. ; Sfrupi Zingiberis, q. s., ut fiat Electuar.
Cochlear, j. vel ij., minima h. s.

Form. 90. Electuarium Febrifugum.
K Pulv. Ci.ichoiiK, fij.; Pulv. Rad. Serpentaris, Pulv.
Cort. CanelliB, aa, 3ij. ; CaraphoriE rasa:, 3ij. ; Upii
Pun, gr. iv. ; Sirupi Ziii^iberis, et Sirupi Aurantn,
aa, q. s., ut fiat Electuarium, cujus capiat 3SS.-3JSS.
pro dose.
Form. 91. Electuarium Febrifugum Hoffmanni.
ft Pulv. CinchoniE, 3vj. ; Pulv Flor. Anthemid., 3'j- ; Ca.-
ryoph. in Pulv., Ext. Centaurii Min., aa, Jss. (vel
Pulv. Centaurii, 3jss.) ; Succi Inspiss. Sambuci Nig.,
gss. ; Sirupi Limonis, fjss. M. Capiat 3j., 4tis horis.
Form. 92. Electuarium Febrifugum Trilleri.
ft Cinchon^e Pulv., ?j. ; Pulv. Flor. Anthem., 3ij.,; Potass*
Nitratis, Ferri Ammonio-Chloridi, aa, 3j. ; Sirupi Au-
rantii, fijss. M. Fiat Electuarium, cujus capiat Coch-
lear., jT-ij., min. pro dose.
Form. 93. Electuarium Ferri Ammonio-Chloeidi

COMPOSITUM.

ft Myrrhae Pulv., 3Jss. ; Ferri Ammonio-Chloridi, gr. xxxv. ;
tere simul, et adde Pulv. Radicis Rubia;, 3jss. ; Pulv.
Castorei, iij.; Sir. Ziiigiberis, fjss., vel q. s., ut fiat
Electuarium ; de quo sumatur, bis quotidie, ad Myris-
ticae Nuclei magnitudinem.
Form. 94. Electuarium Ferri Potassio-Tartratis.
ft Potassse Bitart., ?ij. : Ferri Potassio-Tartratis, 3iij. ; Zin-
giberis, 3]. : Sirupi Aurantii,q. s., ut fiat Electuarium
moUe, CUJUS capiat, 3j--3ij-i l^is terve in die.
Form. 95. Electuarium Nitri Camphor atum.
ft Camphorae rasae et ope Alcoholis pulverizat., gr. vj.-xij. ;
Potassae Nitratis, 3jss. ; Confect. Rosse Gallicie, 5Jss. ;
Sirupi Simp., q. s., ut fiat Electuarium. Dosis, moles
Mynsticse Nuclei subinde capiatur.

Form. 96. Electuarium Purgans.
ft Confectionis Se<ina-., ^ij. ; Pulver. Jalaps, 3j. ; Pota«s.
Bitart. pulv., fss. ; Sirupi Zingiber., 5J. M. Sumat
Cochl., j., min. bis vel ter die.
Form. 97. Electuarium Scills Compositum.
ft Potassffi Bitart. contrit., Jiij. ; Juniper! Bac. et Cacumin.
pulv., m. ; tere bene simul, et adde terendo Pulv. Ja-
lapae, jij. ; Oxymellis Scill*, §ij. ; Sirupi Zingiberis,
q. s., ut fiat Electuarium. Dosis 3j-3''j-) b's, ter, qua-
terve in die.

Form. 98. Electuarium SennjE Compositum.
ft Senna; F<A. pulver., ^ss. ; Potassce Bitart. pulv., 3vi. ;
Pulv. Jalaps Rad.,3ij.; Sod:E Bi-boratis, 3j. ; Sirupi
Zingiberis, §ij. Misce. Dosis i 33.-3ij., pro re nat^.

Form. 99. Electuarium Terebinthin*.
ft Pulv. Tragacanth., 3iv. ; Aq. Purae. 5J. M. Fiat mu-

cilago ; tunc gradatim adde 01. Terebinth., f j. ; et con-

tere cum Sacch. Purif., 31J. ; Pulv. Curcuma;, gr. x., ut

fiat Electuarium.

Form. 100. Electuarium Terebinthinatum.
ft Olei TerebinthinsE, f ij. ; Mellis Despumati, fij. ; Pulv.

Rad. Glycyrrh., q. s., ut fiat Electuarium.

Form. 101. Electuarium VALERiANiE Compositum.
ft Pulv. Rad. Valerian. Minor., 3j. ; Pulv. Sem. SantonicK,
3ij. ; Pulv. Rad. Jalap., gr. xxx.-xl. : Oxymel. Scillse,
q. s., ut fiat Electuarium.

Form. 102. Electuarium Vermifugum.
ft Potassa; Bisulphatis, Pulveris Radicis Jalapae, Pulveris
Radicis Valeriana, 85, 3j. ; Oxymellis Scillitici, f iv.
M. Suinantur adulti, jss., quatuor vices de die, et
pueri, 3j. ad 3ij. (Stoebk.)

Form. 103. Elixir Aloes Compositum.
ft Croci Stig., part. j. ; Potassae Acet., Aloes, Fellis Tauri
Inspiss., 5-5, part. ij. ; Myrrh*, part. ij. ; Spirit. Vini
(vulgo Brandy dirt.), part. xxiv. Infunde et macera
secundum artem, et cola. 3j.-3ijss. pro dose.

Form. 104. Elixir Pectoralis Wedellii.
ft AsafcEtidae, 3ij.; Aridi Benzoici, Opii Purif. Camphors,
Croci Stig., Rad. Scilla", Olei Anisi, 65, 3ij. ; Balsami
Peruv., fss. ; Spirit. Vini Rect., ILijss. Macera, et
cola.

Form. 105. Elixir Proprietatis Rhubarbarinum.

II Aloes Socotrin., fj. ; Rhei, 3vj. ; Myrrh;e, 3iijss. ; Croci

Stigmat., 3iij. ; Carb. Potassae, 3i]ss. ; Vini Madciren-

sis, Ibj. ; Alcohol., Jiij. Macera per dies seiitem, et

cola. (Id dos. 3j.-3ij. Vermifuge, emmenagogue, &c.)

Form. 106. Elixir Robobans.
ft Aloes, Myrrhae, aa, Jij. ; Summit. Absinthii, Sum. Cen-
taurii Minoris, Cinchonae in Pulv., aa, jss. ; Corticis
Aurantii Amari, 3iij. ; Croci, 3ij. ; Vini Albi Ilispan.,
ibij. Macera in sole per horas, xlviij. ; dein adde Sac-
char. Alb., f viij., et cola.

Form. 107. Emplastbum Ammonite.
R- Ammonia; Hydrochloratis, 3j. : Saponis Duri, 3ij. ; Em-
plastri Plunibi, fss. : Emplastrum et Saponem simul
liqua, et paulo antequam concrescant imuiisce Salem
in pulverem tenuem tritum. Extensum super alutam
parti affectbB quamprimum applicatur, et pro re nala
repetatur.

Form. 108. Emplastrum Anodtnum Fortius.

(RiCHTER).

R Emplastri Galban. Comp. (vel. Emp. Cumini), fj. ; Cam-
phoriE, 3j. ; Ammon. Sesquicarbon., Opii Puri, aa, 3ss. ;
Olei Cajeput., gtt. xl. Fiat Emplastrum secundum
artem.

Form. 109. Emplastrum Anvticolicum.
ft Gum. Ammoniaci, Gum. Galbani, aa, f j. ; Terebinthin.
Venet., et Terebinthin. Commun., aa, 3x. : lento igne
liquefactis, adjice Asafcetidae, 5Jss. ; Croci Stigm , jiij. ;
Olei Mentha Pip., et Olei Rutie, aa, 3SS.-3J., et omnia
misce.
Form. 110. Emplastrum Antihystericum
ft Galbani, Sagapeni, aa, ?j. ; Asafoetidie, fss. ; Olei Ruts,
3SS.-3J. ; Aceti Vini, q. s., ad Gum. Resin, liquefacien-
dum; dein adde Terebinthina; Commun., f j. ; Cerae
Flavae, f lij. ; Pulv. Myrrhffi, fss. ; Pulv. Castorei, 3jss. ;
Olei Succini, 3ss. Misce. (The Wurtemberg and
Manheim Pharm.)

Form. 111. Emplastrum Aromaticum Compositum.
ft Emplast. Arora. (PA. Dub.) vel Emp. Cumini, fss. ; Sul-
phuris Sublimati, 3ij. ; Olei Macis, Ttlxxxv. Fiat Em-
plastrum.

Form. 112. Emplastrum BelladonNjF..
ft Extr. Belladonna, part. iij. ; Ammon. Sesquicarbon. Pulv.,
part. j. Misce, et fiat Emplastrum. (To very painful
parts.)

Form. 113. Emplastrum Camphor*:.
ft Olei Olivae, f xij. ; Plumbi Binoxidi, §viij. Liqua, et
massas refrigeratae adjice Camphorae, fijss., solutae ia
pauxillo Olei. Misce bene. (Stahl.)

Form. 114. Emplastrum Defensivum.
ft Plumbi Binoxidi, fviij. ; Aceti, ^iv. ; Olei Olivae, Ibj.
Liqua, et adde Cerae Flavae, f ij. ; Camphorae, f ss.

Misce bene.

Form. 115. Emplastrum Deobstruens.
ft Potassii Sulphureti, Pulv. Conii, 55, 3ijss. ; Camphorae
Pulveris, Terebinthinae Vulg., 55, 3iv. ; S.aponis Albi,
3ss. ; Cerae Flavae, Jj. ; Emplast. Simp., Jiv. M.

Form. 116. Emplastrum Picis.
ft Picis Abietinae vel Nigrae, fvj. ; Cer^ Flavae, f j. ; Tere-
binthiuiE Vulg., 3iij. ; Liquefac simul, et fiat Emplas-
trum.

Form. 117. Emplastbum Resolvens.
ft Emplastri Ammoniaci cum Hydrarg., Emplast. Picis,
Emplast. Galbani Comp., 6a, partes aequales. Fiat
Emplastrum.

Form. 118. Emplastrum Roborans.
ft Emplastri Picis, Empl. Galban. Comp., Empl. Cumini,
5a, partes binas; Ferri Sesquioxidi, Thuris, 55, partem
uiiain ; Olei Pimenta;, q. s., ut fiat Emplastrum.

Form. 119. Emplastbum Rubefaciens.
ft Emplast. Aromat. Comp. (F. Ill), 5ss. Forma in Em-
plast., dein asperge cum Antimouii Potassio-Tartratis,
3j. ; Camphorae Pulveriz., 3j. ; Sulphur. Sublimati,
3ss., in unum admixtis.

Form. 120. Emplastrum Stibiatum.
ft Emplast. Picis, part. xj. ; Terebinth. Venet., part. iv. ;
Antimon. Potassio-Tartratis in Pulv., part. j. Liquefac
Emplastrum et Terebmthinam, et adde Antimonium.
(Niemann and Augdstin.)

APPENDIX OF FORMUI^f:.— Emclsio— ExTRACTUM.

Form. 121. Emulsio Amyodalo-Camphorata.
ft Amygiial. Dulc. decortic, fss. ; Amypdal. Amar. No.,
>iij. ; Aquic Fontauae, 5V1JSS. Fiat Emulsio, cul adjice
Pulv. Gummi Arabici, ^ij. : Camphor* (cum paux. Al-
cohol, subartic), 3j. ; Sirupi Papaveris Albi, ^ss. M.
Et sit Emulsio, de qua sumat quovis bihorio Cochleare
unum, pr^gressa phialie cummoliune.

Form. 122. Emulsio Anticatarrhalis.

ft Sem. Phelland. Aquat. con., 5j- ; Gum. Acaciae, 5j. ■ Aq.
Ferv., fix. Macera, et cola. Colatsc adde Sirupi Al-
thieae, ;ss. ; Vini Ipecac, 3ij. M. Capiat Coch., ij.,
larga 3tiis vcl 4tis horis.

Form. 123. Emulsio Camphorata.
ft Olei Amygdal. Dulc, Jss. ; Gum. Acaciae, q. s. ; Cam-
phors;, gT. X.-3J. ; tcre bend simul, et adde Aquae F(e-
niculi et Aquie L^urocerasi, 5'j. J Sirupi Althaeas, 553.
M. Fiat Emulsio.'

Form. 124. Emulsio Camphorata Anodvna.
ft Camphors Subactan, gr. xvj. ; Amygdal. Dulc, ?ss. ; Acidi
llydrocyanici, Hlxii. ; Aquae Flor. Sambuci, fvj.

Form. 125. Emulsio Camphorata Composita.
ft Camphorae, gr. x.-3j. : subige in Alcoholis, 3ss. ; et

adde terendo Mucilag. Acaciae, 3ij. ; Olei Amygdal.

Dulc, ^ss. ; Sirupi Althaeae, fss. ; Aquae Laurocerasi,

Aquie Fceniculi, 33, f ijss. M. Capiat Coch., j. vel ij.,

3tiis vel 4tis horis.
Interdum adjiciatur vel Vinum Ipecacuanha, vel Vinum

Antimonii, vel Potassae Nitras, vel Sirupus Papaveris

Albi.

Form. 126. Emulsio Nitro-Camphorata.
ft Camphone Subactie, Potassfe Nitratis, 55, 3j.; Pulv.
Gum. Acaciae, jj. ; Infnsi Pectoralis vel Aquae Flor.
Aurantii, f vj«s. ; Sirupi Althaeae, 5j. M.

Form. 127. Emulsio Pectoralis
ft Spermaceti, 3j. ; Gum. Acaciae, 'ij. ; Olei Amygdal. Dulc,
?ss. ; Acidi Hydrocyanici, ITlx. ; Sirupi Simp., Sirupi
Tolutani, 59, fss. ; Aq. Funiculi, fivss. M.

Form. 128. Emulsio pro Tussi.
ft Olei Amygdal. Dulc, ?ss. ; Vitellum Ovi unius ; Aquae
Flor. Aurantii, jvj. ; Mucilag. Acaciae, 5ss. ; Vini Ipe-
cacuauhae, 3jss. ; Sirupi Althsie, fss. M.

Form. 129. Emulsio Sedativa.
ft Mist. Amygdal. Dulc, Mist. Camphorie, 59, fiijss. ; Mu-
cilag. Acaciae, jss. ; Morphiae Acetatis, gr. j.-ij. ; Sirupi
Tolutani, ?ss. Solve Morph. Acetat. in Olei Amygdal.,
nixx. ; deinde adde alia.

Form. 130. Enema Alces et Asaf(etid.e Comp.

ft Eitr. Aloes, 3ss. ; Asafoetidae, 3jss. : Camphors rasa;, gr.
xij. ; Olei Olivae, fjss. ; Decocti Avenae, fxij. Misce.
(In Flatulent Colic, Ascarides, &c.)

Form. 131. Enema Antihystericum.
ft Fol. Ruta>, Fol. Sabinae, 9a, 3ss. ; Aqua; Fervid., q. s.
Coque ad f ivj. ; et adde Asafoetidse, 3ij. ; Olei Olivae,
fij. Misce.

Form. 132. Enema Antispasmodicum. (1.)
ft Tinct. Opii, Ti. ; Infusi Valer., f xv. ; Mucilag. Acaciae,
5i. M.

Form. 133. Enema Antispasmodicum. (2.)
ft- Tinct. Opii, 3SS.-3J. ; Infusi Cuspariae, Decocti AlthaeiE
Officin., 93. fvij. M. Pro Decocto Alth. interdum
vtatur vel Decocto Malvae, vel Decocto Hordei, vel In-
faso Ipecacuauhae.

Form. 134. Enema Asaf(etid«, vel Fcetidum.
ft AsaffBtidiR Gummi ResinE, 3ij. ; Decocti Malvee Compo-
siti, fxv. ; Spiritus Amm(mia; Compos., 3jss. ; Tinc-
turae Opii, 3ss. Misce pro Eneraate.

Form. 135. Enema AsafcetidjE et Terebinthin.e.
ft AsaffPtidK, 3j.-3ij. ; Camphorae rasa", gr. xij. ; tere cum
Decocti Avenae, Jxiij. ; dein adde Olei Terebinth., fss.
ad 3jss. Misce, et hat Enema.

Form. 136. Enema AsAFtETiDiE Compositum.
ft Asafatida;, 3j.-3ij. ; Camphone rasa;, gr. x. ; Decocti
Avenae, fxvij. Misce pro Enemate. Interdum adde
Olei Terebinth., 3iij.-5jss. (la Flatulent Colic,
Worms, &c.)

Form. 137. EnEMA BELLABONNiE.

ft Fol. Belladonoae exsic , gr. xij. (vel Extr. Belladonnx, gr.
2

ss. ad gr. j.) ; Aq. Fervid., fxij. (For Retention of the
Urine from Spasm of the Sphincter VesiciE, or Spasm
of the Rectum.)

Form. 138. Enema CAMPnon* Comp.
ft Camphora; rasa>, gr. xij. ; Olei Juniperi Angl., 3S8. ; In-
fusi Valerianae, 3xv. ; Mucilag. Acaciae, 5J. M. Fiat
Enema.

Form. 139. Enema Camphoratum.
ft Acidi Acetici Camphorati (F. 2), fss.-fj. ; Infusi Vale-
riana;, Jxiij. M. (AuGUSTlN.)

Form. 140. Enema Catharticum.
ft Decocti Malvffi Composit., ?xij. ; Magnesiae Sulphatis,
5j. ; Olei Oliva;, fij. Misce. Fiat Enema.

Form. 141. Enema Colocynthidis Compositum.
ft Colocynthidis Pulpa; incis., 3j. ; Aqaa>, fxij. Coque pau-
lisper, et cola; dein adde Sodii Chloridi (vel Sodae Sul-
phatis) fss. ; Sirupi Rhamni Cath., fss. Misce.

Form. 142. Enema contra Spasmos.
ft Camphora; rasa, gr. v.-x. ; Potasss Nitratis, 3ss. ; Olei
Olivae, f j. ; tere simul, et adde Infusi Valerianie, Decocti
MalviB Comp., Sa, fvij. M.

Form. 143. Enema Emolliens.
ft Flor. Anthemidis, Semin. Lini contus., 35, fss. ; Aquas
Fervid., fxvj. Macera et cola; dein adde Opii, gr.
vj.-xvj. M. Fiat Enema.

Form. 144. Enema Emollio-Aperiens.
ft Decocti Malva-. Comp., fxij. ; Soda; Potassio-Tartratis,
fss. ; Olei OlivE, f ij. M. Fiat Enema.

Form. 145. Enema Opiatum.

ft Tinrtura; Opii, 3j. ; Mucilag. Amyli, fvj. ; Decocti Hor-
dei, f X. Misce. Fiat Enema, tepidum injiciendum.

Form. 146. Enema Saponis.
R Saponis Mollis, f j. ; Aquae Ferventis, Oj, Solve, et te-
pidum exhibe.

Form. 147. Enema Sedativum.
ft Seminum Lini contus., f j. ; Aqus Ferventis, f viij. Ma-
cera per horam : dein cola, et solve in Liq' colato Bi-
boratis Sodae, 3j. ; Opii Extr., gr. ij.-iij. M. Fiat
Enema.

Form. 148. Enema Sedativum Camphoratum.
ft Infusi Lini Comp., fxij. ; Tinct. Opii, 3ss. ; Bi-boratis
SodiC, 3ss. ; Camphors rasa:, gr. x. M. Fiat Enema,
bis terve in die injiciendum.

Form. 149. Enema Terebinthinatum.

ft Camphorae rasae, 3j. ; Olei Terebinth., f ss.-f jss. ; Olei

Olivae, f jss. ; Decocti Avenae, f xiij. Fiat Enema.

Form. 150. Enema Terebinthina;.
ft Terebinthinae Vulgaris, fj. (rel Olei Terebinthinae, fss.
ad fjss.) ; Ovi unius Vitellum. Tere simul, et grada-
tim adde Decocti Avenas tepid., fxv. Injiciatur pro
Enemate seinel in die, pro re nata. (When it is re-
quired to evacuate the lower bowels, Ol. Ricini, fj.,
will be found a useful addition.)

Form. 151. EneMa Terebinthino-Camphoratum.

ft Olei Terebinth., f j. ; Olei Olivae, f j.ss. ; Camphorae rasae,

gr. XV. ; Decocti Avens, fxvj. M. Fiat Enema.

Form. 152. Enema Thebaiacum.
ft Opii Puri, gr. j.-iij. ; Mucilag. Acaciae, fss. ; Lactis Te-
pefact., fxvj. Misce pro Enemate.

Form. 153. Enema Vermifugum.
ft Rad. Valerianae, Herbae Absinthii, Ilerbae Tanaceti Ca-
cum. (vel Sem.) Santonic, 99, 3iij. ; Aq. Fervids, 3xvij.
Macera per horas binas, et cola. Liq. colattradde Sodii
Chloridi, fss. Fiat Enema.

Form. 154. Extractum Aloes Alkalinum Comp.
ft Aloes Spicati Extr. contrit., f iij. ; Zingiberis Radicis
concis., fss. ; Myrrhse Pulv., Croci Stigmat., 39, 3vj. ;
Potass* Carbon, (vel Sodae Carbon.), fss. Macera per
triduum leni cum calore, dein cola. Liquorem defae-
catum consume, donee idoneam habeat crassitudinem.
(Dosis gr. X. ad xix.)

Form. 155. Extractum Dulcamar.e.
R Slipit. Dulcamara;, part. j. ; Aquae Bullient., part. viij.
(Split the shoots of dulcamara longitudinally, and ma-
cerate them in the water for twelve hours; boil for a
quarter of an hour, and express the fluid. Afterward
boil the residue with four parts of water, and linalljr

APPENDIX OF FORMULA.— Extractum—Haitstus.

express. Mix the two liquors, and evaporate with a
gentle heat to a proper consistence.)

Form. 156. ExTRACTUM IIellebori NiGKi Backeri.
B RaJicis IIellebori Nig. exsic, Ibij. ; Potasss Carbon.,
ibss. ; Alcohol. (22 grad.), fcviij.

(Backer directs the above to be digested in a sand-
bath fi>r twelve hours, shaking it frequently, and after-
ward to be expressed and strained. Eight pounds of
white wine are to be poured upon the residue, and di-
gested with it for twenty-four hours in a sand-bath, and
afterward to be expressed and strained. After a few
hours both these tinctures are to be mixed together,
and evaporated with a gentle heat to the consistence of
an extract. This is the best preparation of Hellebore.
Dose from x. to xv. grains.)

Form. 157. Fomentum Camphoratum.
R Camphorae, 5ss. ; Acidi Acetici, Jij. ; Aceti Commun.,
5x. M. (AUGUSTIN.)

Form. 158. Gargarisma Acidi Hydrochlorici.
R Infusi Cinchona;, Jvj. ; Acidi Hydrochloric!, lUxx. ; Mel-
lis, 5SS. M.
Form. 159. Gargarisma Acidi Hydkochlorici Com-

POSITUM.

R Acidi Hydrochlorici, Jjss. ; Decocti Cinchonae, Infusi
Rosae Compos.., aa, siijss. ; Mellis RoscE, f j. M. Fiat
Gargarisma.

Forra. 160. Gargarisma Antisepticum.
R Decocti Cinchona, fvj. ; Camphorae, gr. xx. ; Ammoniie
Hydrochloratis, gr. xv. M.

Form. 161. Gargarisma Astringens.
R Infusus Kramerias, ^vjss. ; Acidi Sulph. Diluti, 3ss. : Si-
rupi Mori, 5J. M. Fiat Gargarisma. (For Relaxa-
tion of the Uvula and Fauces.)

Form. 162. Gargarisma Astringens Zobellii.
R Alumiiii-s Crudi, Potassse Nitrat., aa, Jss. ; Potassae Bi.-
tart., 3i.i. ; Aceti Destil., fij- Solve, et adde Aquae
Rosae, Jvj. M. Fiat Gargarisma.

Form. 163. Gargarisma Bi-boratis Sod^.
R Bi-boratis Sodae, Bij. ; Aqua Rosae, f vij. ; Mellis Despui-
mati, Tincturae iVlyrrhie, aa, f. fss. M.

Form. 164. Gargarisma Catechu Thebaiacum.
R Infusi Rosae, f vij. ; Tincturae Catechu, Jvj. ; Acidi Sul-
phurici Diluti, 3j. ; Tincturie Opii, 3jss. Sit Garga-
risma saepe utendum. (A. T. Thomson.)

Form. 165. Gargarisma Commune.
R Aquae Puras, fxxij. ; Bi-boratis Sodae, 3x. ; Tinct. Cate-
chu, fj.-jiij. ; Tinct. Capsici Annul, ^j.-jiij. ; Mellis
RosiB, ^jss.-Jiij. Interduni adde, loco Bi-boratis Sodie
et Tinct. Catechu, Acidum Hydrochloricum vel Acidum
Sulphuricum.

Form. 166. Gargarisma Potass.f. Nitratis. (1.)
R Potassse Nitratis, jjss. ; Mellis Despumati, fij. ; Aquae
RosiE, 5vj. M. Fiat Gargarisma.

Form. 167. Gargarisma Potass*; Nitratis. (2.)
R Polassas Nitratis, Jij. ; Decocti Hordei, §vij. ; Oxymellis
Siniphcis, fj. M. (Brands.)

Form. 168. Gutt* Acetatis Morphi.s:.
R Morphiae Acetatis, gr. xvj. ; Aquae Destillatae, 3vj. ;
Acidi Acetici Diluti, 3ij. ; Tinct. Cardamom. Comp.,
5ss. M.

Form. 169. Gutt/E .^Itheris Terebinthinat*;.
R Olei Tcrebinthinae, part. j. ; .Sther. SulpViurici (vel
jElher. Nitrici), part. iij. M. (Nearly the same as
that recoiumeiidcd by M. DuRANDE in Jaundice and
Biliary Calculi.)

Forra. 170. Gutt.*; Anodtn<e.
R Morphiae Hydrochloratis, gr. xvj. ; Aquae Destillat^, ?j. ;
Tmcl. Lavaiidul. Coinj)., 5ss. M. (In doses of from
v.to XXX. drops.)

Form. 171. Gutt.e Antiloimjcje.
R Pulv. Cainphora!, Jij. ; Spirit. Rect., sviij. ; Liquoris
Amnion., Jij. ; Ol. Lavandul , jij. M. Fiimt Gutta;,
quarum capiat xx. ad 3j., quovis in idoneo vehiculo.

Form. 172. Gutt.t: contra Spasmos.
R Olei Cajeputi, Tinct. jElhcr. Valerianae (vide Form.),

Tinct. Ammon. Comp., aa, §j. ; Olei Anisi, 3ij. M.
(Illx. ad XXXV.)

Form. 173. Guttle contra Spasmos. (Stoll.)
R Liquoris Ammoniae Sesquicarbon., Tinct. Castorei, Tinct.
Succini, Tinct. Asafcetidae, aa, 3iij. M. (T\\, L., bis
terve in die.)

Form. 174. Gutt*; Nervin.*:.
R Camphorae, Croci, aa, 3jss. ; Moschi, Myrrhae, aa, 3iv. ;
tere cum Sacchar. Albi, f ss. ; et Spirit. Vini Rectific,
3ij. ; dein adde terendo (Jlei Lavand., Ol. Juniperi, Ol.
Rorismarini, Olei Origani, aa, 3iij. ; Olei Succini, Olei
Cajeputi, aa, Jj. ; Olei Limonis, f ss. ; Olei Terebinthins,
f ij. ; Sacch. Albi, fss. ; Spirit. Vini Rect., f ij. Ma-
cera et seiva in vase bene obturate.

Form. 175. Haustvs Acidi Nitrici et Opii.
R Tinct. Opii, ttlxx.-xxx. ; Tinct. Caryoph. (vide Form.),
3j.-3ij. ; Acidi Nitrici, T^ilx.; Aquie Pimentse, Jj. M
Fiat Ilaustus.

Form. 176. Haustus Acidi Nitrici et Opii.
R Acidi Nitrici Diluti, 3ss. ; Tinct. Opii, 3ss. ; Infusi Ca-
lumbae, 3xj. Misce. Fiat Haustus, ter in die capi-
endus.

Form. 177. Haustus Anodynus.
R Mist. Camphorae, 3ix. ; Potassae Nitratis, gr. vj. ; Spirit,
^theris Sulph. Compos., 3j. ; Tinct. Opii, lllx.-xij. ;
Sirupi Papaveris, 3ij. Fiat Haustus, hora decubitus
sumendus.

Form. 178. Haustus Contra Emesin.
R Infusi Aurantii Comp., 3x. ; Spirit. Menthae Virid., 3J. ,
Liq. Potassse, IlLx. ; Magnes. Carbon., 3j. ; Tinct. Hy-
oscyami, 3ss. ; Extracti Humuli, gr. viij. ; Sirupi Zin-
gib., 3j. M. Fiat Haustus.

Form. 179. Haustus Anti-emeticus.
R Magnes. Carbon., 3j. ; Extr. Humuli, gr. vj. ; Liq. Po-
tassffi, Tllviij. ; Tinct. Hyoscyanii, 3ss. ; Spirit. Menthae
Virid., 3j. ; Infusi Aurantii Comp. (vel Infusi Caryoph.
Comp.), 3x. ; Sirupi Zingiberis, 3j. M.

Form. 180. Haustus Aperiens.
R Extracti Rad. Jalapae, gr. xx. ; tere cum Amygdal. Dul-
cibus Num., iv. ; Aquae Cinnam., jjss. Fiat Haustus.

Form. 181. Haustus Aperiens ex Jalafa et Aloe.
R Pulv. Rad. Jalapae, gr. xvj. ; Aloes Socot., gr. x. ; tere
probe cum Extract. Glycyrrh., jss. ; Tinct. Rhei, 3j. ;
Ol. Carui, HUj. ; Aquae Cinnam., 5Js.s. M. Fiat
Haustus.

Form. 182. Haustus Aperiens ex Scammonia
R G. R. Scanimon., gr. xij.; tere cum Glycyrrh. Extracti,
gr. XX. ; Tinct. Rhei, 3ij. ; Sirupi Zingiberis, 3j. , Aq.
Cinnam., f jss. M. Fiat Haustus.

Form. 183. Haustus Astringens.

R QuercOs Corticis cont., fss. ; Aquae Ferventis; f xiij.
Macera per horam, et cola.

R Liquoris Colati, 3xj. ; Tinct. Catechu, 3ss. ; Tinct. Car-
damom. Comp., 3ij ; Sirupi Aurantii Cort., 3j. Fiat
Haustus.

Form. 184. Haustus Boracicus.
R Infusi Lini Co., vel Infusi Althaeae Co., f jss. ; Bi-boratis
Sodie, 3ss. ; Spirit. JElher. Nit., 3ss. ; Sirnpi Papave-
ris, Sirupi Aurantii, aa, 3ss. M. Fiat Haustus, ter
tiis vel quartis hons capiendus.

Form. 185. Haustus cum Calumba et Ferro.
R Infusi Calumbae, 3xj. ; Tincturse Ferri Sesquichloridi,
lIU'v. ; Tiiictur:fi Calumbae, 3j. Fiat Haustus, bis die
sumendus.

Form. 186. Haustus Camphor.* Comp.
R Camphorte, gr. ii.-vij. ; Tinct. Calumbs, Spirit. Anisi
aa, 3jss. ; Aqua; Pimentie, Aquae Menth. Virid., aa, 3v
Tere Camphoraiu cum Tincturi et Spiritu ; dein adde
gradatiin Aquas. Fiat Ilaustus, hora somni, vel ur-
genti vomitu, sumendus. Si sit occasio, adde Tinct.
Opii, 111,x,-xx., vel Tinct. Hyoscyami, 11|,xv.-xxv.

Form. 187. Haustus Carminativos.
R MagnesitE Carbon., 3j. ; Pulv. Rhei, gr. x.-3ss. ; Olei
Anisi, llliij. ; Liq. Potassa, Itlxij. ; Liquoris Ammoniae,
lllxx. ; Aquae Anethi, fij. M. Fiat Haustus.

Form. 188. Haustus Colchici.
R Vini Colchici min., xxv.-xxxv. ; Magnes. Carbon., 3j. j

Aquae Cinnam , Aqua;, aa, 3vj. M.

APPENDIX OF FORMULAE.— Haustus—Inpusum.

^ Form. 189. IIaustus cum Colchico.

R Potassie Sulphatis, 3ss. ; Sodip Sesquicarbonatis, 3ij. ;
Aquae Ancthi, ?jss. ; Tiiict. Calunibw, ^jss. ; Vini Col-
chici, Hlxxv. fiat IIaustus cum Acidi Tartaric! granis
quindeccm in Aquic semifliiid-uncia solutis, et in iiiipe-
tu efl'ervescentiiE sunicndus.

Form. 190. IIaustus Conii.
R Infusi Conii (F. 230), 5j. ; Liq. Ammon. Acet., Jij.-Jiij. ;
Tinct. Hyoscyami vel Conii, Vlixv. ; Sirupi Papaveris,
5ss. M. Fiat IIaustus.

Form. 191. IIaustus Conii et Hyoscyami.
R Extracti Conii, Extracti Hyoscyami, 55, gr. v. ; Mucila-
giiiis AcarisE, jij. Tore siniul donee quam optime mis-
crantur, ct dcinde adde Liquoris Ammoniae Acctatis,
Aquic Purao, 55, Jss. ; Sirupi Rhasados, ^j. Fiat Haus-
tus, quartft qu&que hora sumeudus. (PaBIS.)

Form. 192. IIaustijs Deobstruens et Roborans.

R Rad. Angelica; contus*, ;;ijss.-5ss. ; Rad. Calumba; con-
""isa;, 3jss. ; Rad. Rhei cont., 3ij. ; Baccarum Capsici
cont., gr. XXV. ; Aquie Fervcntis nctarium dimidiuin.
Macera per horas duas, dcinde cola.

R Hujns Infusi, 3x. ; Tinct. Calumbae, 3j. ; Potassse Sul-
phatis, gr. XXV. ; Sirupi Aurantii, 3j. M. Fiat IIaus-
tus, bis quotidie sumendus.

Form. 193. IIaustus Diaphoreticbs.
R Infusi Serpentaris Comp. (F. 262), fj. ; Liq. Ammon.
Acet., 3iij. ; Sirupi Aurantii, 3j. M. Fiat Haustus,
bis tervo in die sumendus. (Dyspepsia, with dr.y,
harsh skin, languor, and debility of pulse.)

Form. 194. Haustus Diureticus. (1.)
R Potassae Acetatis, 3j. ; Oxymel. Colchici, 3ij. ; tere cum
Aquse Funiculi Dulcis, jj. ; Spirit. Juniperi Comp., 31J.
M. Fiat IIaustus, bis terve in die sumendus.

Form. 195. Haustus Diureticus. (2.)
R Acidi Nitrici Diluti, 3ss. ; SpirilOs ^5;theris Nitrici, 3j. ;
Infusi Digitalis, 3iij. Aquai Destillata;, 3ix. ; Sirupi
Zingiberis, 3ij. M. Fiat Haustus, ter in die sumen-
dus.

Form. 196. Haustus Diureticus. (3.)
R Potassie Acetatis, 3ss. ; Infusi Quassise, Aq. Cinnamomi,
aa, 3vJ. ; Aceti Scillie, Spirilfls jEtheris Nitrici, aa,
3ss. M. Fiat Haustus, ter in die capiendus.

Form. 197. Haustus Diureticus. (4.)

R Tinctune Jalapae, 3ij. ; Areti Scillae, 3j. ; Aqua: Menthae
Viridis, fjss. Fiat Haustus.

Form. 198. Haustus Emeticus excitans.
R Pulv. Radicis Ipecacuanhse, jss. ; Ammonise Sesquicar-
bon., 3j. ; Aqua; Menlhae Piper., jijss. ; Tinct. Capsici,
3j. ; Olei Aiitheniidis, Tllx. M. Fiat Haustus emeti-
cus. (In Poisoning from Narcotics, <fcc.)

Form. 199. Haustus Guaiaci Compositus.
R Tincturae Guaiaci, 3j. ; Mellis, 3j.; tere simul, et adde
Decoct. Senegae, fss. ; Aquae Pimentae, fj. ; Ammonia
Sesqiiicaibonalis, gr. vj. Fiat Haustus, sexta quique
hord sumendus.

Form. 200. Haustus Infusi Cinchonje cum Acido
Htdrochlorico.
R Pulveris Cinchome, 5J. ; Confectionis Ross, fjss. ; Aquae
Ferventis, Oj. ; tere ben6, et per horam, in vase clause,
infunde.
R Liquoris Colati, 3xj. ; Tinct. Cinchonae, 3j. ; Acidi Hy-
drcichlorici Diluti, Tllviij. M. Fiat Haustus, ter quo-
tidie sumendus.

Form. 201. Haustus Infusi Cuspari/E Compositus.
R Corticis Cusparia contus., 3ij. ; Rad. Calumbae contusae,
3jss. ; Rad. Rhei, 3j.; Sem. Cardani. contrit., 3ss. ;
Sem. Anisi cont., 3ss. ; Aquse Ferventis, 5XV. Macera
per horas duas, et cola.— R Hujus Infusionis, ?j. ; Tinct.
Cinnam., 3jss. ; Spirit. Ammon. Aroinat., litxxv. ; Si-
rupi Aurantii, 3j. Fiat Haustus, ter quotidie sumen-
dus. (In all diseases of Debility, excepting Hectic Fe-
ver, and in Relaxation of Mucous Surfaces.)

Form. 202. Haustus Infusi Uv^ Ursi Alkalinus.
R Infusi Uvffi Ursi, fjss.-Jij. ; Potassa; vel Sodae Carbon.,
gr. XV. ; Tinct. Hyoscyami, 3ss. (vel Tinct. Opii Cam-
phor., vel Extr. Conii) ; Sirupi Papaveris, 3ss. Fiat
Haustus, ter quaterve quotidie sumendus. (In Affec-
tions of the Urinary Organs, and of the Air Passages.)

Form. 203. Haustus Infusi Vvm Ursi Compositus.
R Infusi Uvffi Ursi (F. 267), 3xiv. ; Acidi Sulphur. Dil.,

Itlxi. ; Tinct. Digitalis, Uliv. ; ^irupi Papaveris Veri,
3jss. M. Fiat Haustus, ter quaterve quotidi6 sumen-
dus. (In Chronic Laryngitis, Ilronchitis, <&c.)

Form. 204. Haustus cum Iodinio.
R Liquoris Potassii lodidi lodiur. Concent. (F. 328), lllvj.-
XV. ; Aquie Destillata;, 3J. ; Sirupi AlthatiE, 31J. M.
Fiat Haustus.

Form. 205. Haustus Laxans.
R Potassae Tartratis, 3j. ; Infusi Sennas Compos., Aquse
PiiiiciitiR, 55, 3vj. ; Tinct. Jalapae, 3j. M. Fiat
Haustus.

Form. 206. Haustus cum Plumbi Acetate.
R Plumbi Acetatis, gr. j. Solve in Aquie RosiB, fj. ; et
adde Oxymellis Simplicis, 3j. ; Tinct. Opii, 71|,v. ; Tinct.
Di^ntalis, Itlx. Fiat Haustus, quartis vel seztis horis
sumendus.

Form. 207. Haustus QuiNiE et Zinci.
R Zinci Sulphatis, gr. ^-j. ; Quina Sulphatis, gr. ij. ; In*
fusi Rosifi Compos., 31. ; Tincturae Aurantii, Sirupi
Aurantii, 55, f. 3j. M. Fiat Haustus, quartcL qu4que
horu sumendus.

Form. 208. Haustus Sedativus.
R Extr. Conii, Extr. Hyoscyami, 55, gr. iv. ; Mucilag.
Acaciae, 3ij. ; tere simul, deinde adde Liquoris Ammon.
Acet., 3iij. ; Mist. Oamphorie, Jv. ; Sirupi Rhitados, 3j.
M. Fiat Haustus, quarlil vel quimii quaque hold su-
mendus.

Form. 209. Haustus Sedativus Emolliens.
R Infusi Lini Co., vel Infusi Althieae Co., Jjss. ; Bi-boratis
SodiE, 3ss. ; Spirit, ^ther. Nit.,3ss. ; Sirupi Papave-
ris, Sirupi Aurantii, a5, Jss. M. Fiat Haustus, tertiis
vel quartis horis capiendus.

Form. 210. Haustus contra Spasmos. (1.)
R Aqus Menthae Virid., fj. ; Liq. Ammon. Acet., 3ij. ;
Spirit. Amnion. Arom., Spirit. JEther. Sulph. Co.,
Tinct. Lavand. Co., aa, 3ss. ; Tinct. Opii, Il[xx. M.
Fiat Haustus, statim sumendus, et pro re nata repe-
tendus.

Form. 211. Haustus contra Spasmos. (2.)
R Infusi Caryophyl., 5jss. ; Spirit. Pimentae. Spirit. Roris-
niarini, 5a, Jss. ; Tinct. Opii, Itlxx. ; Olei Cajeputi,
lllx. M. Fiat IIaustus, ut supra sumendus.

Form. 212. Haustus contra Spasmos cum Pilula
Camphor*.
R Mist. Camphorae, f j. ; Spirit. ./Etheris Sulphur. Comp.,
Tinct. Camphor;e Comp., 55, 3j. ; Tinct. Hyoscyami^
3SS. ; Sirupi Papaveris, 3jss. M. Fiat Haustus, iu-
terduni cum Pilula sequeuti sumendus.
R Camphoric rasa;, gr. j.-iij. ; Ammon. Sesquicarbon., gr.
iij.-vj. ; Mucilag. Acacia;, q. s. M. et fiat Pil. j. vel ij.

Form. 213. Haustus Stimulans.
R Aq. Cinnam., 5Jss. ; -Magnes. Carbon., 3ss. ; Spirit. Am-
mon. Arom., 3ss. ; Spirit, ^iher. Arom., 3j. ; Olei Ro-
risinanni, HlviJ. M. Fiat Haustus.

Form. 214. Hacstus Stomachicus.
R Calumbae Rad. concisae, 3j. ; Acori Calami Rad. contusae,
f ss. ; Rhei Rad. contusae, 3jss. ; Cardam. Sem. con-
trit., 3ss. ; Aquae ferventis octarium dimidium. Macera
per horam, et cola. — R IIujus Infusionis, 3xij. ; Tinct.
Aurantii, 3j. ; Potassae Carbon, (vel Sodae Sesquicar-
bonat.), gr. xij. Misce. Fiat Haustus, bis terve quo-
tidie sumendus.

Form. 215. Haustus Stomachicus Aperiens
R Sod;e Pot. -Tartratis, 3ij. ; Sodae Sesquicarbonatis, 3ij. ;
Aqua; Anethi, fss. ; Infusi Anthemidis, fj. ; Tinct. Ca-
hinibai, Tinct. Aurantii Co., 55, 3j. M. Fiat IIaustus
cum Acidi Tartarici granis quindecini, in Aquae semi-
lluid-uncia solutis, in impetu effervescentia; sumendus.

Form. 216. Haustus Terebinthinatus Aperiens.
R Olei Terebinth., 3ij.-3v. ; Olei Ricini, 3jss.-sjss. ; Olei
Limonis, et Olei Cajeputi, 55, Tlliv. ad xij. ; Magnesiac,
35s. ; Aqua; Mentha; Virid., 5j.-5ij. M. Fiat Haustus,
jiro re iiati capiendus. (In Puerperal, Infectious, and
Malignant Fevers.)

Form. 217. Haustus cum Uva Ursi.
R Pulv. Fol. Uva; Ursi, gr. xv.-3j. ; Potasss Nitratis, gr.
xij. ; Pulv. Tragacanth. Comp , 3j. ; Aq. Anethi,

5 JSS. M-.

Form. 218. Infusum Amarum.
R Summit. Absinthii Artem., 5j. ; Corticis Aurantii, Jss.,

APPENDIX OF FORMULA.— iNFtJsuar.

Rhei, 3ij. ; Rad. GentianE, 3j. ; Aquae Ferventis, f xij.

Macera per horam, et cola.
R Liq. Colati, ?jss. ; Potassx Carbon,, gr. xij. (vel Liq. Po-

tassic, IIUxij.) ; Tiiict. Aurantii Co., Jj. ; Spirit. Anisi,

3j. ; Sirupi Ziugib., 3ss. M. Fiat Haustus, bis terve

quotiJi* sumemius.

Form. 219. I«fusum Angelicje Compositum.
Jl Fol. vel Rad. Angelicas Arch., f ij, ; Rad, Serpentar.,

fss. ; Florum Sambuci Nig., f j. ; Potassa; Carbonat.,

Jiij. ; Aquae, tbij. Macera per boras Ires, ct cola-
11 Liq. Colati, ?jss. ; Spirit. Juniper. Comp., Jj. ; Tinct.

Opii Co., Tlli. Fiat Haustus. (In Atonic Dropsy, &c.)

Form. 220. Infvsum Anthemidis Compositum,
R Flor. Anthemidis, fss, ; Semin. Anisi cont., Jiij. ; Fol.
Menlh. Virid,, fss. ; Caryoph, cont,, 3j. ; Aurantii
Cort. Sic, 3ij. ; Aquae Fervid,, Ibjss. Macera per ho-
ram, et cola.

Form. 221. Infusum ARMORACiiE Compos,
R Sinapeos Semin. contus., Armoraciae Radicis concisa;, 55,

3iij. ; Aquae Ferventis, Oj. Macera per horam, et cola.
R Liq. Colati, fvij. ; Spirit. Ammon. Arom,, 3jss. ; Spirit.

Pimenta;, 3iij. M. Capiat Coch., ij., ampla, ter quo-

tidie.

Form. 222. Infusum Arnice. (Ph. Mil. Dan.)
R Flor. Amies, 3j. ; Flor. Anthemid., Jss. ; Herbx Menthae
Piper., 3ij. ; Aquae Fervidae, fx. Macera, et cola. (Do-
sis 5J.-5JSS.)

Form. 223. Infusum Arnict: Compos.
R Amicae Montan. Herbae, Summit. Artemis. Vulg., S5,
fss. ; Herbae Centaureae Benedict, Rad. Calami Arom.,
aa, 3ij. ; Aquie Fervid^, f xvj. Macera per horas binas,
et cola. Liq. colato adde Tinct. Aurantii, Spirit. Pi-
jnentiE, aa, Jss. ; Spirit. Rorismarini, 3ij. M. (Dosis
^£«.-fjss., bis terve in die.)

Form. 224. Infusum Artemisi* Vulgaris Co.
R Summit. Artemis. Vulgar., 3vj. ; Herbae Centaureae Bo-
ned., 3iij. ; Aquae Fervid., fxvj. Macera per horas bi-
nas, et coJa. Liq. colato adde Spirit. Juniperi Comp.,
^j. ; Olei Rorismarini, Itlxij. M. (In Epilepsy from
Exhaustion, Chlorosis, &c.)

Form. 225. Infusum Barberis.
R Barberis Corticis contusi, Jss. ; Aquie Ferventis, Oss.
Macera per horas binas in vase leviter clauso, et cola.
(Dosis 5j . ad ^ij,, bis ter quotidie : interdum cum Sodse
Carbonate, vel Potassae Carbonate, vel Tinct. Ca-
lunibae.)

Form. 226. Isfusum Calami Aromatici.
R Calami Radicis contuBie, 3iij. ; Aquae Ferventis, Oss.
Macera per horas duas, et cola ; dein adde Tinct. Cal-
ami, fss.

Form. 227. Infusum Calami Aromatici Compositum.

R Rad. Calami Arom. conciss, 3jss. ; Flor. Anthemid.,
3j. ; Aurantii Cort. exsic, 3j. ; Caryoph. cont-, 3ss. ;
Aquae Ferventis, Oss. Macera per quartam horae par-
tem, et cola. Liquori colato adde Potassa Carbon.,
3J--3ij-

Form. 228. Infusum Caryophylli Comp.

R Caryoph. contus., 3j. ; Cort. Aurantii Sic, 3ij. ; Semin.
Coriandri et Seiii. Anisi cont., aa, 3ss.,' AquE Ferven-
tis, tbj. Macera per semi-horam, et cola.

Form. 229 Infus. Cinchon/e cum QuiNjE Sulphate.

R Cinchonae Cordifol. Corticis in Pulv., 3TJ. ; Confectionis
Rosae, 5jss. ; Aqu* Ferventis, Oj. Tere bene, et di-
gere per horas duas in vase clauso ; dein cola.

R Liq. Colati, fvj. ; Sulphatis Quinae, gr. viij. ; Acidi Sul-
phur. Diluii, lltxxiv. Fiat Mist., cujus Coch. ij , larga
tertiis vel quartis horis sumenda.

Form. 230. Infusum Conii.
R Conii Fol. exsiccat., 3ij.; Anisi et Coriandri Semin.
contus., aa, 3jss. ; Aquse Ferventis, Oss. Macera per
horas duas, et cola. (Dosis 3j. ad fij., bis, ter, qua-
terve in die.)

Form. 231. Infusum Diosm£ Crenat,e.
R Fol. Diosniifi Crenatse, jss. Aquse Ferventis, Oss. Ma-
cera per horas quatuor, et cola. (Dose ?j.-?jss.)

Form. 232. Infusum Gentian,e Alkalinum Compos.

R Radicis Genlianie concisie, 3ij. ; Corticis Aurantii Sic,

3j. ; Semin. Coriandr. contus., 3j. ; Rorismarini Cacu-

iiiin., 3j. ; Potassae Carbon, (vel Sodie Carb.), 3j. ; Aquae

Ferventis, f xij. Macera per horas duas, et cola.

Form. 233. Infusum Guaiaci CoMPOSlTniH.
B '^uaiaci Ligni ras., Ibss. ; Glycyrrhizae Radicis contussf,
^j. ; Sassafras Corticis Verae concisae, js». ; Coriandri
Seniinum contusorum, f j. ; Liquoris Calcis, Ovj. In-
funde per dies tres, deiu cola ; cujus sumat aeger qva-
tuor sexve uncias pro dose, et bis die repetatur,

(SPRAGUE.)

Form. 234. Infusum Glechom,e Hederace/e, cum

ACIDO HVDROCYANICO.

R Glechomae Hederaceae, vel Hederae Terrestris, f ss.-3vj. ;
Radicis Glycyrrhizae, 3iij. ; Aquae Ferventis, Oj. Ma-
cera per horas tres, et cola.

R Liq. Colati, f jss. ; Acidi Hydrocyanic!, THj.-iij. ; Sirup
Althaeae Officin, 3jss. M. Fiat Haustus, aext4 vel oc
tava quaque hor& sumendus.

Form. 235. Infusum Juniperi.
R Juniperi Baccarum contusarum, f ij. ; Aquae Ferventis,
Oj. Macera in vase leviter riauso per horas duas, et
cola ; dein adde SpiritOs Juniperi Compositi, Jj. ; et in-
super, pro re nata, Potassae I5itartratis, 3ijss. (Dosis,
fluidunc. ij. ad iv., ter quaterve quotidie.)

Form. 236. Infusum et Mistura Juniperi Composit.

ft Baccarum Junip. contus., 3ijss. ; Semin. Anisi contus.,
Semin. Foeniculi cont., aa, 3jss. ; Aquae Ferventis, Oj.
Macera per horas tres ; dein cola.

R Liq. Colati, fxiij. ; Potass* Nitratis, 3jss. ; Sodse Car-
bon., 3jss. ; Tinct. Scillae, 3jss. ; Spirit. Junip. Co.,
3ijss. ; Tinct. Opii, TUxxv. Fiat Mist., cujus capiat
Cyathum subind4.

Form. 237. Infusum Marrubii.

R Marrubii Herbae exsic, fss. ; Aquae Destillatae Ferventis,
Oss. Macera per horam, et cola.

ft Liq. Colati, f jss. ; Tinct. Camphorae Comp., 3j. ; Ext.
Glycyrrh., gr. x. .M. Fiat Haustus, ter in die sumen-
dus. (Chronic Bronchitis, and Catarrh with inordinate
Secretion.)
Form. 238. Infusum Meliss,e Compositum.

ft Melissae Officinalis exsic, Radicis Glycyrrh. contusae, 55,
3ijss. ; Sem. Anisi cont., Sem. Foeniculi, Sem. Coriand.
cont., aa, 3ss. ; Aquae Bullientis, Ibij. lufunde per ho-
ram, et cola.
Form. 239. Infusum Mentha et Caryophylli.

ft Folior. Menthae Virid. Sic, 3iij, ; Rosae Gallicae Petal.
Sic, 3Jss, ; Caryophyllorura contus , 3jss. ; Aurantii
Cort. Sic, 3js3. ; Aquae Ferventis, Oj. Macera per
horam, et cola.

Form. 240. Infusum Menth.e Compositum. (1.)
ft Fol. Menth. Virid. exsic, Radicis Glycyrrh. concis. e
cont., aa, fss. ; Semin. Anisi et Semin. Coriand. con-
tus., aa, 3j. ; Aquae Ferventis, q. s., ut fiat Colaturae
Oj. (Adde Magnes. et Sacch. Album pro torminibus
infantum ; aut interdum Acidi Sulphurici Arom., 3J.,
pro nausea vel vomitu.)

Form. 241. Infusum Menth,e Compositum. (2.)
ft Mentha Viridis exsiccat. contusae, f jss. ; Rosae Gallicae
Petalorum exsiccatorum, 3j. ; Aquie Ferventis, Oj. ;
Acidi Sulphurici Diluti, 3ij. ; Sacchari Purificati, fjss.
Menthae et Rosae Petalis superinfiinde Aquam cum Acidi
dimidio mistam, Macera; dein Liquorein effunde, et
Saccharum, et Acidum reman, adjice. (Dosis i flu-
idunc j, ad ij., bis, ter, saepiusve quotidie.)

Form. 242. Infusum Menyanthis.

ft Menyanthis Foliorum, 5ss. ; Zingiberis Radicis concis.,
3ij. ; Aquae Ferventis, Oss. Macera in vase clauso per
horas duas, et cola. (In doses of Jj. to jjss., with Spir-
iiu.s .iEtheris Nitrici, 3j. ad 31J., in Rheumatism, Ar-
thritic Affections, and in Cachectic and Cutaneous Dis-
eases.)
Form. 243. Infusum Millefolii Compositum.

ft Herbae Millefolii, 3ij. ; Herbae Rorismarini, Herbae Thymi
Vulg., aa, 3j. ; Semin. Coii.iud, cunt,, 3j. ; Aq. Fer-
ventis, Ibj, Infunde per horam, et cola,

ft Liquoris Colati, ?jss, ; Spirit. Rorismarini, 3ss. ; Tinct.
Aloes Comp., 3j.-3ij' Fiat Haustus, primo mane quo-
tidie capieudus. (In Chlorosis, AmenorrhtEa, <S:c.J

Form. 244. Infusum Pectorale. (I.)
ft Herb. Malvae Off., Herb. Tussilag., Radicis Althaea, Rad.
Glycyrrh., aa, Jj. ; Semin. Anisi, f ss. ; Aq. Fervid,
quantum velis. Macera.

Form. 245. Infusum Pectorale. (2.)
ft Rad. Althaiac, Herb. Melissae, Herb. Menthae Viridis, Flor
Sambuci, Flor. Arnica;, aa, 5j. ; Senun. Anisi, ffs. M
Sint loco These.

APPENDIX OF FORMULAE.— Infosum—Injectio.

Form. 346. Infusum Quassia Comp.
R Radicis Calumbie concls., 3j. ; Ligni Quassix, Jjss. ; Aq.
Ferventls, q. 8,, ut sint Ciilaturie, f vijss. ; adile Zinci
Sulphatis, gr. iv. ; Acjdi Sulphur. Arom., 3j. ; Tinct.
Aurantii Co., 3iij. M.

Form. 247. Infusum Quassia cum Aqua Calcis.
R Has. Lign. QuassiiE, jss. ; Aq. Calcis Vivie, fvij. Stent
in digestione per horas, xxiv. ; cola, et adde Aq. Mcuth.
Virid., 5ij. ; Sirupi Aurantii, ^ss. M.

Form. 248. Infusum Rhatania.
R Krameriae Radicis contus., 3iij. ; Aquae Ferrentis, Oss.
Macera per horas sex in vase leviter clausu, et liquo-
rem cola.

Form. 249. Infusum Rhei.
R Rhei Radicis concis., 3jss. ; Aqua; Ferventls, Oss. Ma-
cera Radiceni per horas duas in vase leviter clause, et
cola; dein adde Sacchari Albissiiiii, 3ij. ; Olei Mentha;
Viridls, gtt. viij., solutas in Spiritu Menthae Piperit;e,
f j. Tunc misceantur.

Form. 250. Infusum Rhei Alkalinum.
R Rhei Rad. concis. et contus., 3ij. ; PotassiB Carbon., 3J. ;
Aqute Fervid., Oss. Macera per horas quatuor, cola,
et adde Tinct. Cinuam., Jss.

Form. 251. Infusum Rhei Alkalinum.
R Infusi Rhei, Jvij. ; Potass* Carbon., 3ijss. ; Tinct. Sen-
nae, et Sirupi Seuuae, 3a, 3iijss. M.

Form. 252. Tnfusum Rhei Comp.
R Rhei Rad. concis. et contus., Jss. ; Cort. Canells Albae
cont., 3ij. ; Flor. Anthemid., Corticis Aurantii, 58, 3iij. ;
Semin. Foeniculi cont., Sem. Coriandri cont., Sa, 3j. ;
Aquae Ferveutis, tbjss. Macera per horas quatuor, et
cola. Liquori colato adde Potassa: Carbon., 3ij. ; Tinct.
Ciunam., fj. M.

Form. 253. Infusum Ross et Aurantii Comp.
R Rosae Gallicae Petal. Sic, 3iij. ; Aurantii Cort. exsic,
3ij. ; Linionis Cort. Recent., 3j. ; Caryophyl. contus.,
5jss. ; Aq. Ferventis, Ojss. Macera per horam, et cola.
Liquori colato adde Sacchar. Albi, 5j.

Form. 254. Infusum Rut« Comp.
R Herb. RutsR, Flor. Anthemid., Radicis Calami Arom.,
&a, 3iij. Macera cum Aquae Fosniculi, fx., per horas
tres, et cola. Liq. colato adde Camphorae, 2)j. ; pniis
in Mucilag. Acaciae, q. s., solutie ; Spirit. JEther. Nit.,
fss. M.

Form. 255. Infusum SALViiE Compositum.
R Herb. Salvias, Semin. Sinapeos, at, fss. ; Aquae Fervid..
Itij. Macera per horam, et cola. Liq. colato adde Spi-
ritOs Arinoraciae Comp., 51J. M. Capiat Coch. ij.-iij.,
ter quaterve in die.

Form. 256. Infusum Sambuci cum Antim. Tart.
R Flor. Sambuci, Jj. ; Aq. Fervid., q. s.,ut sit Colat., f vj. ;
cui adde Oxymel. Simplicis, Oxym. Scillitici, 45, 5j. ;
Antimoiiii Put. -Tart., gr. ij. M. Capiat Coch. j-, om-
nia hor4. (Augustin.)

Form. 257. Infusum SantonicjE Seminum Com-
positum.
R Semin. Artem. Santonics cont., Rad. Valeriana; Opt.,
aS, fss. Iiifunde in vase clauso cum Aq. Fervid., fix. ;
Cola, et adde Aq. Menth. Virid., fij. ; Extr. Rutae, 3j. ;
Tinct. Valeriana; Conipositae, 3iij. M. Capiat fss.-jjss.,
pro dose. {In Hysteria, Chlorosis, Ainenorrhcea,
Worms, <J:c.)

Form. 258. Infusum Sarz£ Alkalinum.
R Sarzs Radicis concis. et contus., f iv. ; Glycyrrhizae Ra-
dicis contus.; 3J. ; Liquoris Calcis, Oiv. Macera per
horas xxiv., in vase bene clauso, saepe agitando.

Form. 259. IsFusuM Senega: et SERPESTABiiK Comp.

R Rad. Senega, Rad. Serpentariae, Sa, f ss. ; Aq Fervid.,
Oj. Macera in vase clauso per horam, et cola. Liq.
colato adde Camphorie, 3ss. ; prills solula; in .Athens
Sulphurici, 3iij. ; Aquae Cinnam., 3J. ; Sirupi Allhaeie,
et Sirupi Papaveris, 55. ;ss. M. Capiat Cochlearia
ij., larga, 4tis horis. (IIecker.)

Form. 2G0. Infusum Sennx Compositum.
R Sennae Foliorum, Jss. ; Coriandri Seminum contus., 3j. ;
Zingiberis Rad. contus., 3j.; Extracti Glycyrrhizie,
3jss. ; Aq. Ferventis, Oss. M.icera per horam in vase
leviter clauso, et Liquorem cola.

Form. 261. Infusu.m Sennje cum Manna.
R MannE, Jij. ; Fol Senna;, 5jss. ; Potassae Bi tart., Semi-

num Anisi contus., 55, 3ij8s. ; Semin. Coriand. Sat.
contus, 3jss. ; Aq. Ferventis, Oij. Infunde per hoias
quatuor, et cola.

Form. 262. Infusum Serpentari* Compositum.
R Serpentariae Radicis, Contraycrvae Radicis, singulorum
contus., 31J. ; Aq. Ferventis, Oss. Post macerationeiu
in vase aperto per hnras duas, Liquorem cola, et adde
Tinct. Serpentariae, Jss. vel fj. (Cum Liq. Ainmou.
Acet., <tc.)

Form. 263. Infusum et IIaustus Scoparii Composit.
R Scoparii Cacum. concis., 5J. ; Marrubii Vulgar. Fol.,

5ss. ; Aq. Ferveutis, Ojss. Macera per horam, et

cola.

R Infusi Colati, 3xj. ; Spirit. JEther. Nit., 3ss. ; Spirit. Ju-
niperi Comp., 3j. Fiat IIaustus, ter quaterve quotidie
sumendus.
Form. 264. Infusum Spioelije Compositum.

R Spigeliae Radicis concis., fss. ; Senna Folior., jij. ; Au-
rantii Corticis cone, Santonicie Seminum contus., Fie-
niculi Semin. contus., 55, 3j. ; Aq. Ferventis, fxij. Ma-
cera per horas duas in vase leviter clauso, et cola.
(Dosis, Cyathus Vinosus singulis auroris, jejuno ven-
triculo. — In Lumbricis. Sprague.)

Form. 265. Infusum Tilije Compositum.
ft Florum Tiliae Europ., ?ss. ; Rad. Althseae Officin., 3iij. ,
Flor. Auran., 3ij. ; Aq. Ferventis, Ibij, Macera per
horam ; exprime, et cola.

Form. 266. Infusum et Mistura Tonico-Aperiens.
ft Sennae Foliorum, f ijss. ; Gentiana; Radicis ccmcis., 3iij. ;
Aurantii Corticis exsic, 3ijss. ; Limonis Corticis Re-
centis, 3iijss. ; Semin. Coriandri contus., 3ijss! ; Zin-
giberis Rad. concis., 3jss. ; Aq. Fei-ventis, Oij. Mace-
ra bene in vase clauso per nocteni iutegram (vel per
horas octo) ; exprime bene, et cola. Liq. colato adde
Magnesiae Sulphatis, Tinct. Cardamom. Comp., 5a,
f iij. ; Spirit. Vini Rect., 3iij. M. (Dosis 5J.-?jss.,
pro re nai^.)

Form. 267. Infusum Vvm Ursi.
ft Uvae Ursi Folior., 3ij. ; Aq. Ferventis, Oss. Macera in
vase clauso per horas tres, prope ignem, et cula.
(With the Alkaline Carbonates in Nephritic Cases,
&c. ; and with the Mineral Acids, &c., ia Affections
of the Air Passages.)

Form. 268. Infusum Valerianae.
ft Valerianae Radicis contus., ?ss. ; Aq. Ferventis, ?xij
Macera in vase clauso per horas duas. Liquori colato
adde Tinct. Lavandul. (Jomposita, Sirupi Aurantii, 55,
fss. (Dosis, fluidunc. ij , ter quaterve quotidid.)

Form. 269. Infusum Valerian*: Compositum.
ft Radicis Valeriana, Rad. Calami Aromatici, aa, concis. et
cont., fss. ; Flor. Arnica Montana, 3ij. ; Aq. Ferven-
tis, Jxvj. ; Liquoris Potassa, Jj. Macera per horas bi-
nas vel tres ; exprime, et adde jEtheris Sulphur., 3iij. ;
et interdum Tinct. Lavandul. Comp., 3iij., vel Extr.
Ruta vel Extr. Taraxaci, jiij. M. (Dosis 5SS.-5JSS.,
ter quaterve in die.)

Form. 270. Infusum Valerian.* et Serpentari^;
Comp.
ft Rad. Valerianae, Rad. Serpentaria, Flor. Sambuci Nig.,
35, 3ij. ; Aq. Fervid., fix. Macera per horas binas, et
cola. Liq. colato adde Acidi Sulph. Arom., 3jss. ; Si-
rupi Papaveris, fss. M. (Fevers, Hysteria,and other
Nervous Affections.)

Form. 271. Infusum Zingiberis.
ft Zingiberis Radicis concis., 3jss. ; Aqua Ferventis, Oss.
Macera per horas duas in vase leviter clauso, et cola ;
turn adde Tinct. Zingiberis, Sirupi ejusdeni, aa, ?ss.
(This is the best vehicle for giving the Liquor. Ferri
Oxygenati, and it is also a very grateful aromatic in
cases of Flatulency.)

Form. 272. Injectio Aceti Ptrolignei.

ft Acidi Pyrolignei, part, j.-ij. ; Mist. Camphora, Aq. Rosae,

oa, part, ij-iij. ; Tinct. Camphora Co., part, ss.-j.

Form. 273. Injectio Argenti Nitratis.

No. I. No. 2. No. 3.
ft Argenti Nitratis . . . 3j. 3ij. 3j.

Aq. Deslillatee . . . Jiij. fiij. Jiij.

Solve.

Form. 274. Injectio Astringens.
R Infusi Quercus, ut supra, fiv. ; Pulv, Gallarum, gr. ixr. ;
Tinct. Catechu, 31J. Fiat Mist., ex quo injicitur paui-
illum, vel per vaginam vel per anum, pro Leucorrhoea,
vel Sanguinis Fluxu.

XIV

APPENDIX OF FORMULAE.— Injectio—Linimentum.

Form. 275. Injectio Boracica.
R Aq. Rosoe, fiv. ; Aq. Flor. Aurantii, f ij. ; Bi-boratis
Soda", 3j. ; Tinct. Caniphorse Conip., iij.-jss'. M.
Fiat Injectio.

Form. 276. Injectio Zinci Acetatis Composita.
It Zinci Sulphatis, Plumbi Acet., aa, 5ss. ; Camphorje, 3ss. ;
Opii, 3ij. Solve in Aq. Bullientis, Oj. ; cola, et fiat
Injectio, ter quaterve iu die utenda; phiala agitata.

Form. 277. Iodidum Hydkargyri.
(lutemally, in doses of from one grain to three, and exter-
nally in ointments.— (Vide Unguent. lod. Hyd.) For
the best account of the preparations and uses of Iodine,
consult Dr. O'Shaughnessy's translation of Lugol on
Scrofula.)

Form. 278. Iodidum Plumbi.
(Intenially, in doses of from half a grain to five grains ; and
externally.— Vide Ung. lod. Plumbi.)

Form. 279. JuLEPUs Sedativus.
R Camphors, gr. vj. ; Spirit, .^ther. Sulphur. Comp.,
3Jss. ; Potassae Nitratis^ gr. xij. ; Aq. Flor. Aurantii,
^iij- ; Sirupi Althiea;, Jiij. ; Sirupi Papaveris, 3ij. M.
Fiat Mist., cujus capiat tertiam partem omni horft, vel
bihorio. (PiERQUiN.)

Form. 280. LiNCTus AciDi Hydrochi.orici.

H Mellis Rosae, 3x. ; Acidi Hydrochlorici, lUxx. ; Sirupi

Khceados, 3ij. M. Simul agita, ut fiat Linctus.

Form. 281. Linctus Boracicus.
R Cetacei, 3ijss ; Pulv. Tragacanlhse Comp., 3iij. ; Sirupi
Tolutani, fj. ; Bi-boratis Sodse, 3jss. ; Confect. Rosie,
3v. ; Sirupi Althaea, fj., vel q. s. Fiat Linctus, de
quo lambat pauxillum ssepe. (Sore Throat, (Esopha-
gitis, &c.)

Form. 282. Linctus Camphoraceus.
R Camphors, gr. xij. ; Pulv. Gum. Acacise, 3j. ; Sirupi Al-
thieiE, jij. Misce bene. (Niemann.)

Form. 283. Linctus Chlorureti Calcis.
R Chlorureti Calcis, gr. iij. ; solve in Aq. Destil., f j. ; et
adde Mellis, fjss. M. Capiat itifans Cochleare unum
minimum submde. (In Softening of the Digestive Mu-
cous Surface.)

Form. 284. Linctus Demulcens. (1.)
R Olei Amygdal. Dul., Sirupi Althteae, aa, fij. ; Sirupi Pa-
paveris, 3xj. ; Vini Ipecacuanhae, 3jss. ; Vitellum Ovi
unius. M. Fiat Linctus.

Form. 285. Linctus Demulcens. (2.)
R Cetacei, 3ijss. ; Pulv. Tragac-anthap Comp., sjss. ; Sirupi
Papaveris et Sirupi Tolutan., aa, f ss. ; Potassie Ni-
tratis, 31j. ; Confect. Rosar., 3vj. ; Sirupi Simp., q. s.,
ut fiat Linctus, de quo lambat pauxillum pro re nata.

Form. 286. Linctus Demulcens et Aperiens.
R Sirupi Violae, fijss. ; Olei Amygd. Dul., ?j. ; Sirupi
ScilliB et Sirupi Seiinae, aa, Jss. M. Fiat Linctus.
(Infantibus.)

Form. 287. Linctus Emolliens. (Brendellii.)
R Saponis Venet., 3iv. ; solve in Olei Amygdal. Dulcis,
f jss. ; Mannse Purif., fss. ; Potassae Bitart., 3ij. ; Sirupi
Althaea, f j. M. Fiat Linctus.

Form. 288. Linctus Myrrhs: et Ipecacuanhje.
R Myrrhae G. R , 3j. ; Pulv. Ipecacuan., gr. vj. ; Oxymel.
Scillae, Mucilag. Acaciaa, Sirupi Althaeae, aa, Jvj. Fiat
Linctus, de quo lambat pauxillum saepe.

Form. 289. Linctus Oleosus. (1.)
R Olei Amygdalarum, Sirupi Mori, aa, fjss. ; Confect.
Fruct. Rosae Caninae, Jij. ; Pulv. Tragacanth. Comp.,
3iij. Misce. Cochleare minim. subindS deglutiatur.

Form. 290. Linctus Oleosus. (2.)
R Olei Olivae, Jjss. ; Oxymellis SciUae, Sirupi Papaveris,
aa, 3J. Dosis, Cochleare parv. j., urgenti Tusse. (In
common Catarrhal Cough, with Sore Throat.)

Form. 291. Linctus Opiatus.
R Sirupi Papaveris, Jij. ; Mucil. Acaciae Ver^, 5jss. ; Conf.
Fruct. Rosae Caninae, 5J. ; Acidi Sulph. Diluti, 31J.
Misce. Dosis, Cochleare minim, subind^.

Form. 292. Linctus Opiatus cum Scillje.
R Sirupi Papaveris, fj. ; Sirupi Mori, 3vj. ; Sirupi Limo-

nis, 3ss. ; Oxymellis Scillae, fss. Misce. Dosis Coch-
leare minim. Tusse urgenti.

Form. 293. LiNCTU« Pectoralis.
R Pulv. Sem. Anisi, Pulv. Sem. Funiculi, Extr. Glycyrrh.,
aa, 5SS. ; Pulv. Sem. Carui, 31J. ; Potassae Nitratis, 3j. ;
01. Anisi, 3ss. ; Sirupi Althaeae, Jvss. M. Fiat Linc-
tus. Capiat 3j., pro re nata.

Form. 294. Linctus Potass^ Nitratis.
R PotassiE Nitratis contr., "jss. ; Mellis Rosae, fj. ; Oxy-
mellis Simplicis, fjss. M. Capiat Coch. minim., pro
re nata.

Form. 295. Linimentum Ammonia cum Oleo Tere-

BINTHINi:.

R Liquoris Ammon., Jss. ; Olei Olivae, fj. ; Olei Tere-
binthinae, Jss. ; Olei Limonis, 3ss. Agita simul donee
misceantur.

Form. 296. Linimentum Ammonia: et TEREBiNTHiNa;

Comp.
R Liquoris Ammon., 5J. ; Olei Olivte, J ij. Misce ben^, et

adde Tinct. Camphors, fij. ; Olei Terebinth., jiij. ;

Saponis Duri, 3v. Misce bend, dein adde, Olei Cajeputi,

3j. ; Olei Limonis, 3jss. M.

Form. 297. Linimentum Anodynum. (1.)
R Opii, fj. ; Camphorae, Jij. ; Liq. Ammtm., fiv. ; Saponis
Duri, Jiv. ; Olei Terebinth., Jviij. ; Olei Limonis,
Jss. ; Spirit. Rorismarini et Spir. Lavandul., aa, f xij.
Misce.

Form. 298. Linimentum Anodynum. (2.)
R Linimenti Saponis Comp., Jj. Liquoris Ammonioe, 3iij. ;
Olei Caryophylli, 3J. ; Tinct. Opii, fss. M. Fiat
Linimentum.

Form. 299. Linimentum Camphorae Fortius.
R CamphorsE rasae, 3ijss. ; solve in Tinct. Cantharidis, 3ij.,
et Tinct. Capsici Annul, 3jss. : dein adde Linimenti
Saponis Comp., fss. ; et gradatim, miscendo, Liquoris
Ammon., 3tj. ; Olei Olivae, 3xj. M. Fiat Linimen-
tum, cum quo illinatur pars affecta bis terve quotidiC.

Form. 300. Linimentum Cantharidum Comp.
R Tinct. Cantharid., 3iij. ; Olei Terebinth., fj. ; AmmonijB
Liq., 3jss. ; Saponis Duri, 3j. ; Olei Cajeputi, 3ss. M.
Fiat Linimentum. (Altered from Augustin.)

Form. 301. Linimentum Febrifugum.
R Antimonii Potassio-Tartratis, gr. xxv. ; solve in Aqus
Destil., 3ij., vel q. s. ; delude tere bene cum Adipis
Praepar., fj., et fiat Linimentum. (The antimony is
partially absorbed without producing any Phlogosis.)

Form. 302. Linimentum Iodinii.
R Linimenti Saponis Co., f j. ; Iodinii, gr. viij. vel x.

Misce.

Form. 303. Linimentum Phosphoratum.
R Olei Olivarum Optimi, fviij. ; Pho.sphori excisi, gr. ix.
Solve cum calore, cola ex frigido, et fiat Linimentum.
(In Paralyse locale, Marasmo, Rheumatismo, et Arlhri-
tide Chronico.

Form. 304. Linimentum Pvrethri.
R Tinct. Pyrethri, 3vj. ; Linimenti Camphorae, Jiv. ; Li-
quoris Ammon., 3ij. Misre. Fiat Linimentum.

Form. 305. Linimentum Rubefaciens.
R Camphorie, 3j. ; Olei Olivae et Liq. Ammon., aS, fj. ; Olei
Macis, Itlxxxv. Misce. (Externally to parts in deep-
seated Inllammation.)

Form. 306. Linimfntum Saponis et Camphor* Comp.

R Saponis Med., f j. ; Alcoholis Rect., fvj. ; Camphora: et
Aq. Destil., aa, f j. Solve leni cum calore, et adde Olei
Rorismarini, 3i'v. ; Olei Thymj, 3j. ; Liquoris Ammo
niae, f ij. Misce bene.

Form. 307. Linimentum contra Spasmos.
R Olei Olivae, Olei Terebinthinte, Liquoris Ammon., Tinct.
Opii, Linimenti Saponis Compositi, aa, fss Fiat Lin-
imentum.

Form. 308. Linimentum Stimulans.
R Linimenti Camphorae Compositi, Linimenti Saponis Com-
positi, aa, 5]ss. ; Olei Crotonis, 3j. ; Olei Cajeputi,
3jss. Fiat Linimentum.

Form. 309. Linimentum Sulphuro-Saponaceum.
R Potassii Sulphureti, ?iij. ; Saponis Albi, Olei Olivffi, aS,
Ibj. ; Olei Vulat. Thymi, 3j. M. (Jadelot.)

APPENDIX OF FORMULAE.— LiNiMENTUM—MisTCRA.

Form. 310. Linimentum Tabaci.
R Tabaci Foliorum, 5j. ; Axungiie Porcinac, Ibj. Simul li-
quefac et macera prope igiicm duucc friabilia siiil fulia ;
tunc exprime. (Ph. Amst.)

Form. 311. Linimentum Terebinthin.k Comp.
ft Linimenti Saponis Co., Linimenti Camphors Co., aa,
jjss. ; Olei Terebinth., ?ij. ; Saponis Uuri, st). ; Olei
Limonis et 01. Cajepilti, 3j.-5'j. M. Fiat Lini-
mentum.

Form. 312. Linimentum Terebinthino-Phospho-

BATUM.

R Olei Terebinth., fij. ; Camphorae rasw, jij. ; Linimenti
Ammon. Fort., fij. j Saponis Medicin., 3ij. ; Phosphori
Puri, fcr. x.-xij., prius soluti in Olei Cajeputi, vel in
Olei Caryophyl., 3ij.,vel q. s. M. (In Chronic Rheu-
matism and Epidemic Cholera.)

Form. 313. Linimentum Thebaiacum Compositum.
ft Opii Puri, 3ij. ; Camphorae, Succini, 55, 3ss. ; Spirit.
Vini, Jvj. Misce pro Linimento.

Form. 314. Linimentum Volatile.
ft Olei Olivae, f iv. ; Camphorae, jij. ; Liquoris Ammon., 5ij.
Misce.

Form. 315. Liquor Acetatis Morphi*:.
ft Morphiae Acetatis, gr. xvj. ; Aq. Destillatae, jvij. ; Acidi
Acetici, ITlx. ; Spirit. PimeutiE, 3v. Solve. (Dosis a
mv. ad tlUxx.)

Form. 316. Liquor Antimonii Pctassio-Tartratis.
ft Antimonii Potassio-Tartvatis, gr. xxxij, ; Aq. Destillatae,
fxiv. ; Spiritus Rectificat., fij.; Uvarum Passarum,
demptis acinis, fij. Macera per hebdomadam, et colu.

Form. 317. Liquor Balsamico-Aromaticus. — Balsa-
mum Vitm Hoffmanni.
ft Balsami Peruvian!, 3j. ; Olei Succini, Olei Rutas, Olei
Rorisniarini,01ei Lavand.,01ei Carynph.,01ei Pimentae,
a5, 3SS. ; Spirit. Vini Reclificati, jxjss. Misce ben^.
(In doses of from 10 to 30 drops on Sugar, or in a suita-
ble vehicle.)

Form. 318. Liquor Bi-boratis Sod* Comp.
R Bi-boratis Sodae, Potassae Bitart., aa, fss. ; Aq. Desfil.,
Oj. (Dosis 3j.-3iij., pro Infantibus ; et f ss.-fiij., ter die
pro Adultis.)

Form. 319. Liquor Calcii Chi.oridi. (Beddoes.)
R Acidi Hydrochlorici, Aq. Destillata, aa, f iv. ; Marmoris
Albi PuIt., q. s., ad saturandum.

Form. 320. Liquor Camphorae JEthereus.
ft Camphors rasae, 3j. ; jEtheris Sulphurici, fj. Solve.
Capiat Itlxx.-xl. , super Saccharum vel in Vini Hispan.
Cyatho. (Proposed by Bang, and adopted in most of
the Continental Pharin.)

Form. 321. Liquor Ferri Oxygenati. (Beddoes.)
ft Ferri Sulphatis, fss. ; Aridi Nitrici Fortissimi (per
pond.), fss. Tere probe siniul in mortario vitreo donee
effervescentia peracta ; dein adde pradatim Aq. Destil-
latae, f jss. Postea per chartam cola. Dosis a quatuor
ad decem guttas, ter quaterve, quotidie, in QuassiE,
Tel Zingiberis, vel Caryophylli, Infusioue. (In Worms,
Haemorrhages, &c.)

Form. 322. Liquor IIydrargybi Bichloridi.
R Hydrargyri Bichloridi, gr. iv. ; Acidi Hydrochlorici, Hlvj. ;
Aq. DestiUatiE, fj. ; Spirit. Tenuioris, 3vj. ; Tincturie
Croci, 3ij. Tere probe simul in mortario vitreo ut fiat
Solutio Incip. sunicndo, Tllxx., nocte maneque ex
haustu InfusOs Lini, vel Decocti Glychyrrhizie ; poste-
aque pro re natd augeatur. (Sprague.)

Form. 323. Liquor Potassii Iodidi.
R Potassii Iodidi, gr. xxiv. ; Aq. Destillatae, fj. Solve te-
rendo in vase vitreo. (Dosis Ttlx.-xxx.)

Form. 324. Liquor Potassii Iodidi Ioduretus.
R Potassii Iodidi, gr. xxxvj. ; lodinii. gr. z. ; Aq. Destillats,
3x. Solve terendo in vase vitreo. (lu doses of 10
drops to 30, thrice daily.)

Form. 325. Liquor Morphi* Citratis.
R Morphi-.e Pur*, gr. xvj. ; Acidi Citrici Crystal., gr. viij. ;
Aq. Destillata:, f j. ; Tinct. Cocci, q. s. Solve. (Dosis
Ulv.-xxv.)

Form. 326. Liquor Plumbi Acetatis Dilutus.
B Liquor Plumbi Acetatis, 3j. ad 3ij. ; Acidi Acetici Diluti,

3iij. ; Spirit. Rectificati, 3jss. ; Aq. Destillatte, f liv.
Misce .

'* Form. 327. LiQUOB Potassae Chlobatis.
ft Potassae Chloratis, 3j. ; Aq. Destillat., fxij. (In indolent
Sores as a LoUon, and internally in three times its bulk
of vehicle.)

Form. 328. Liquor Potassii Iodidi Ioduretus Con-
centratus. (Lugol.)
ft lodinii, 3j. ; Potassii Iodidi, 3ij. ; Aq. Destillatas, 3vij
Solve. (This solution contains one twenty-fourth pai
of Iodine. Dose for an Adult, six drops in sugared Wa
ter in the morning fasting, and six an hour before din
ner ; increasing Ihe dose, every week, two drops, unl.
it reaches to thirty or thirty-six daily.)

Form. 329. Liquor Potassii Iodidi Ioduretus Dilu-
tus. (Lugol.)

No. 1. No. 2. No. 3.

ft lodinii gr. J gr. j. gr. jl

Potassii Iodidi . . . gr. jss. gr. ij. gr. ijss.

Aq. Destillat* . . . fviij. fviij. fviij.
Solve.

Form. 330. Liquor Zinci Acetatis.
ft Zinci Sulphatis Purif., gr. xxiv. ; Aqua; Destillatae, f iv.

Solve,
ft Plumbi Acetatis, gr. xxxij. ; Aq. Destillatae, fiv. Solve.

Misceantur Solutiones ; quiescant paulisper ; dein co-

lelur Liquor,

Form. 331. LoTio Acidi Hydrocyanici.
R Acidi Hydrocyanici, fss. ; SpiritOs Rectificati, f j. ; Aq.
Destillatae, fxss. Misce, et fiat Lotiu, dihgeuter
utenda.

Form. 332. Lotio Antiphlogtstica.
ft Liquoris Plumbi Diacetatis, 3vj. ; Liquoris Ammon. Ace-
tatis, fiv. ; A.). Puras, tbij. Misce.

Form. 333. LoTio Antipsokica.
R Potassii Sulphureti, fiv. ; Aquae, Oj. ; Acidi Sulphurici,
3iv. Misce. Fiat Lotio, bis terve quotidie utenda.
(Dupuytren.)

Form. 334. LoTio Boracica.

ft Bi-boratis Sodae. 3j. ; Aq. Rosae, Aq. Flor. Aurantii, aa,
fiij. M. Fiat Lotio.

Form. 335. LoTio Evaporans.

ft .SItheris Sulphur., Liquor. Ammon. Acet., Spirit. Vim

Rect., aa, f jss. ; Aq. Rosie, f lijss. M. Fiat Lotio.

Form. 336. LoTio Evaporans Astringens.
ft Ammoniffi Hydrorhloratis, 3ij. ; Liquoris Ainmon. Acet.,
f lij. ; Aquae Purae, fxij. Misce.

Form. 337. LoTio Flava.

ft Hydrargyri Bichloridi, gr. xv. ; Liquoris Calcis, ftj.
Misce.

Form. 338. LoTio Hydrargyri Camphorata.
ft Hydrargyri, 3j. ; Acidi Nitrici, fij. ; Aq. DestiUatiR, Ov.
Hydrargyrum digere cum Acido Nitrico, et Aquam De-
stillatam adde, dein Camphorae, 3ss. ad f ij.ss., adjice.
(In Chronic Cutaneous Affections, applied twice daily.)

Form. 339. LoTio Sedativa.
ft Acidi Hydrocyanici, 3j-3ij. ; Mist. Amydal. Amarse,
f vijss. ; Hydrarg. Bichloridi, gr. lij.-v. Fiat Lotio, ope
spongiae partibus affectis applicanda.

Form. 340. LOTIO TEREBINTHINiE ET CaMPHORjE.

ft Camphoric, 3iv. ; Spirit. Vini Rect., Olei Terebinthinie,
55, fiv. M. Fiat Lotio, in Morbis Cutaueis Cbronicis
utenda.

Form. 341. LoTio Terebinthinata.
ft Olei Terebinthinae, Alcoholis, iia, f iv. ; Camphorae, Jvj.
Fiat Lotio. (In Pityriasis, <kc.)

Form. 342. Mistura Acetatis Morphij;.
R Morphiae Acetatis, gr. ij. ; Acidi Acetici, jss. ; Mist. Cam-
phors;, f vss. ; Tiuct. Humuli, 3iij. ; Sirupi Tolutani,
3j. M. Fiat Mist., cujus capiat Cochleare unum am-
plum tertii vel quarts qu&que hor&.

Form. 343. Mistura Acidi Boracici.
ft Acidi Boracici, 3j. ; Mist. Camphorae, fiv. : Sirupi Au-
rantii, fj. M. Capiat Cochleaiia, ij., 2d& vel Slid,
quaque hord. (In Cerebral Affections. Chaussier.)

APPENDIX OF FORMULAE.— MisTUKA.

Form. 344. Mistura Acidi Hydrocyanici Comp.

R Acidi Hydrocyanic!, 11lviij.-xx. ; Vini IpecacuanhiE, 3ij. ;
Spirit. -5:theris Sulphurici Comp., 3iij. ; Mist. Cam-
phora;. Mist. Amygdal. Dulc, aa, Jiijss ; Oxymellis
Scills, 3ij.-5ss. M. Capiat Cochlear. j.,vel ij.,vel iij.,
ter quaterve quotidi*.
Form. 345. Mistura Acidi Hydrochlorici.

R Acidi Hydrochlorici, 3j. ; Decocti Hordei, Oj. ; Sacchari
Purific'ati, Jss. Misce. (Dosis A fluidunc, ij. ad iv.,
bis, ter, siepiusve quotidie.)

Form. 346. Mistura Acidi Nitrici Comp.
R Extracti Hyoscyami, 3ss. ; Acidi Nitrici Diluti, 3j. ;
Aqua Desullats, Jvss. ; Sirupi Ziugiberis, 3iij. M.
Fiat Mistura. (Dosis unc. j., secundis horis, durante
paru.iiysmo.)

Form. 347. Mistura Alkalina Anodyna.
R Tinct. Opii, 3ij. ; Liquoris Potassae, 5ss. ; Spiritus Myris-
tici, fss. ; Aq. Pur<e, fxjss. Misce. (Dosis £i 5j- ad Jij-,
bis terve in die.)

Form. 348. Mistura Alkalina Cardiaca.
R Mist. Camph., f vjss. , Sodan Carbon., 3jss. ; Ammon. Ses-
quicarbon., 3j. ; Tinct. Calumbae, Jss. ; Spirit. Anisi,
Tinct. Cardamom. Co., 35, fss. M. Capiat Cochlea-
ria ij., magna, bis terve quolidie.

Form. 349. Mistura Aloes et Guaiaci Comp.
R Tinct. Aloes Comp., Tinct. Guaiaci, Spirit. Ammonis
Aromat., aa, ?ss. ; Tinct. Ferri Amnionio-Chloridi, 3iij.
M. Capiat 3j. vel 3ij., ter de die, ia vehiculo quovis
idoueo.

Form. 350. Mistura Ammoniac! Comp. (1.)
R Mist. Ammoniaci, f vjss. ; Potassce Nitratis, 3j. ; Aceti
ScilliE, Jiij.; Spirit. Junip. Comp., f j. ; Tinct. Opii,
Tllxij. Fiat Mist.jCujus capiat Cochleare amplum 3tiis
vel 4tis horis.

Form. 351. Mistura Ammoniaci Comp. (2.)
R Gummi Ammoniaci, ;j. ; Oxymellis Scills, ?j. ; Vini Ip-
ecacuanhae, 3j. ; Aquae Flor. Sarabuci, 3IVSS. ; Sirupi
Papaveris, 3ij. M. Capiat aeger qualibet hori Coch-
leare uuum. (Chronic Pectoral Complaints.)

Form. 352. Mistura AmmonijE Hydrochloratis.
R Hydrochloratis Ammoniae, Extr. Glycyrrh., aa, 3j. ; De-
cocti Althffiffi, 5vj. ; Oxyniel. Simp., jj- (vel Oxyrael.
Scillae.) M. (Catarrhal Affections.)

Form. 353. Mistura Anodyna.
R Magnesiae Carbon., 3jss. ; Tinct. Hamuli, 3iij. ; Aquae
Menlh. "Virid., Jiij. ; Infusi Caryophyl., Jiijss. M.
Fiat Mist.,cujus capiat Cochlearia ij., largapro re natjl,
vel urgenti NauseS.

Form. 354, Mistura Anodyna. — (Infantilis.)
R Testae Praeparatie, 3ij. ; Sirupi Papaveris Alb., 5j. ; Spiri-
tus Ammon. Foetid., 3j. ; Olei Anethi, Olei Foenicul.
Dulc, aa, TH.11J. j Aquae Destillatje, Jiij. Fiat Mistura.

Form. 355. Mistuka Anodyna Acetosa.
R Mist. Camphortc, fiv. ; Liquoris Ammon. Acet., fiij- ;
Acidi Acet., 3ij. ; Spirit. jEther. Nit., 3ij. ; Vini Ipe-
cacuauhae, 3ij. ; Extracti Conii, gr. xxx. ; Sirupi Tolu-
tani, 3ij. M. Fiat Mist., cujus capiat Cochlearia ij.
vel iij., larga, 4t4 vel quinta qu&que horft.

Form. 356. Mistura Anodyna cum Zinco.
R Zinci Sulphatis, gr. vj. ; Mist. Camphorae, Jvij. ; Acidi
Sulphur. Arom., 3ss. ; Tinct. Hyoscyami, 3jss. ; Tinct.
Camphora; Comp., 3iij.; Sirupi Limonum, Jij. M.
Capiat Cochlearia ij., larga, ter quaterve quotidie.

Form. 357. Mistura Anti-emesis.
R Magnes. Carbonat., 3J63. ; Spirit. .Silther. Sulph. Comp.,
3113. ; Tinct. Cardamom. Co., Jss. ; Spirit. Anisi, 3v. ;
Olei Carui, THx. ; Sirupi Zingiberis, 3ijss. ; Mist. Cam-
phora;, Jjss. ; Aq. MenthiE Viridis, fvss. Fiat Mist.,
cujus suniantur Cochlearia duo ampla, urgenti Flatu
vel Nauseft.

Form. 358. Mistura Antiphlogistica. (1.)
H Potassae Nitratis, 3ss. ; Liquoris Ammoniae Acetatis, fjss. ;
Vini Antimonii Potassio-Tartratis, 311J. ; Mist, Amyg-
dalarum, 5vj. Fiat Mistura, cujus sit dosis Cochlearia
tria magna, quarts qu&que horft.

Form. 359. Mistura Antiphlogistica. (2.)
R Liquoris Ammonias Acetatis, Aq. Mentha Vindis, iS,
I ij. ; Aq. Destillatae, Jiijss. ; Potassae Nitratis, 3ij. ;
Vini Antimomi Potassio-Tartratis, 3iij. Fiat Mistura,

cujus sit dosis Cochlearia tria ampla, terti^ vel qaart^
quiique hor4.

Form. 360. Mistura Antiseptica.
R Acidi Hydrochlorici Dil. vel Acidi Acetici, .^theris Sul-
phur., aa, 31J. ; Aq, Pimentae, Jivss. ; Aq. Ciuuam.,
51J. ; Sirupi Aurantii, f j. M. Suiuantur Coch. duo,
omui biliorio.

Form. 361. Mistura Aperiens.
R Magnesiae Sulphatis, Jv. ; Magnesia Carbonatis, Jiijss. ;
Aq. Destillatae, Oij. ; Spiritus C'limainomi, Spintfis
Anisi, aa, 3ij. ; Tinct. Cardam. Co., Jss. Fiat Mistura.
Dosis & 5j. ad Jij.

Form. 362. Mistura Aperiens Salina.
R Florum Anthemidis, Jij- ; Radicis Zingiberis conciss,
5j. ; Aq. Ferventis, Oijss. Macera per noctem ; ex-
prime, et adde Magnes. Sulphatis, f ij. ; Sodae Sulpha-
tis, fjss. ; Potassae Sulphatis, 3v. M. Capiat Cyathum
prinio mane. (After each dose take an hour's exercise
in the open air, and breakfast afterward.)

Form. 363. Mistura Aromatica.
ft Infusi Caryoph., Jiv. ; Aq. Cinnam., Jiij. ; Tinct. Cin-
nam., 3ij. ; Magnes. Carbon., Jjss. ; Confect. Arom.,
3j. M. Fiat Mist., cujus sumat Coch. ij., larga.

Form. 364. Mistura Arsenicahs.
ft Liquoris PotassiE Arsenitis, 3jss. ; Tinct. Cardam. Comp.,
3v. ; Aquae Cinnam., Jiij. : Aq. Destillatae, fiv. M.
Fiat Mistura. Dosis Cochlearia ij. (f j.), 3liis vel 4tis
horis.

Form. 365. Mistura Arsenicalis cum Opio.
ft Liquoris Potassae Arsenitis, Ttlxl. ; Confectionis Opii,
3 IV. ; Aq. Menthae Viridis, fiv. M. Capiat partem
4tam post jeutaculum, prandium, et oceuam. (Dr.
Cleghorn.)

Form. 366. Mistura Asaf<etid.e.
ft Asafoetidae, 3j. ; Liquoris Ammon. Acet., Aq. Pulegii, aS,
Jiijss. M. Cap. Cochleare unum, vei duo, pro dose.

Form. 367. Mistura Asafcetid^ Comp.
R AsaftEtidf, 3j. ; tere curii Aquae Menth. Virid., fv. ; dein
adde Tinct. Castorei, 3iij. ; Tinct. Valer. Cbmp., 3ij. ;
./Ether. Sulphur., 3j. Fiat Mist., cujus capiatur Coch-
leare unum amplum, secundis horis.

Form. 368. Mist. Asafcetidje et Valerianae Comp.
ft Tinct. Asafcetida;, Tinct. Gentianae Compositae, Tinct.

Valerianae, Spintus Ammoniae Arom., Si, Jss. M.

Sumatur Cochleare unum minimum ex Aquie tostae

cyatho.
Form. 369. Mistura Balsami Peruvian!.
ft Balsami Peruviani, 3ij. vel iij. ; Mellis Despumati, fj.

Simul diligenter tere, et gradalim adde Aq. Destillatae,

Jvij. Dosis A fluid. 3j. ad Jss., bis, ter, quaterve quo-

tidid.

Form. 370. Mistura Balsami Tolutani.
ft Tinct. Balsami Tolutani, 3ij. ; Mucilaginis Acariae, fj.
Misce ; adde gradalim, Aq. Destillatie, fiv. ; Tinct.
Camphorae Comp., Sirupi Simplicis, Sla, Jiij ; Ammon.
Sesquicarbonatis, 3ss. (vel sine). Misce. Fiat Mistu-
ra, cujus capiat Coch. ampl. ij., ter in die.

Form. 371. Mistura Bechica.
ft Pulveris Tragacanthae Compos., 3ij. ; Aq. Destillatie,
Jxij. ; Sirupi Simplicis, 3vj. Misce. Interdum adde,
vel Nitratis Potassse, 3iv., vel Tinct. Opii, TIlxl., vel
Tinct. Hyoscyami, 3jss., vel Tinct. Camphors Comp.,
5SS., vel Oxymellis Scillae, 3vj., vel alium medicameu-
tum idoneum.

Form. 372. Mistura Camphor.*.
ft Camphorae, 3j. ; tere cum Spirit. Rectificati, TIlix. ;
Magnesiae Carbonatis, 3ij. ; et Sacchari Purificati,
3ij. ; dein adde gradatim, Aq. Destillatae Ferventis, Oj.
M. Fiat Mistura.

Form. 373. Mistura CamphoB/E Composita.
ft Camphors rasae, gr. xij. ; Magnesiae Carbon., 3j. ; Gum.

Acacia in Pulv., 3j. ; Mist. Amygdal. Dulc, 5 vjss. ;

Tinct. Opii, lIUxx. (vel Tinct. Hyoscyami, 3j.) ; Sirupi

Papaveris Alb , 3iij. M. (In Affections of Mucous

Surfaces, &c )

Form. 374. Mistuka Camphorata.
R Camphorae, gr. viij.-xvj. ; Alcoholis, Hlvj. ; Sacchari AIbi,

Pulv. Acaciae, Magnes. Calc, a&, 3ij. ; Aquae Pure

fvijss. M.

Form. 375. Mistura Camphorata. (Ph. Dan.)
ft Camphors Pulverizatae, 3ss. ; Gum. Acaciae, Sacchari

APPENDIX OF FORMULA— MisTtjR A.

AU)i, SB, 'ij. ; Magnesia, Jss. ; Dccocti Althsese Ofli-
cmalis, ^vijss. M. (Intpriiuni adde Tinct. Opii, vel
Tiiict. Hyoscyami, vel Vinuni Ipecacuanha;, vel Spirit.
jTIther. Nit., vel ^ther. Sulphur., vel Exit. Cunii,
^c, &c.)

Form. 376. Mistura Carminativa.
S Ma?nosi» Sulphatis, 5jss. ; Magnesia Carbonatis, jijss. ;
Tiiict. Carilamoiiii Cdiiip., 'jss. ; Tinct. Castorei, lllxl. ;
Olei Anisi, lllx. ; Aq. Anethi. ;xij. ; Aquie Pura;, 5VI1J.
Misce. Dosis i 31J. ad 5jss., 4tis vel 6lis horis.

Form. 377. Mistuba Carminativa Deobstruens.
R Infusi Mcnthae Carvophyl. (F. 239), ^vij. ; Potassaj Bi-
snlphatis, ^ijs,s. ; Acidi Sulphur. Dil., Jj. ; Spirit. Pi-
nienta;, Spirit. Carui, aa, 5jss. ; Spirit. Myristicffi, Jij. ;
Sarchari Albi, Jij. Fiat Mist. Capiat Cochlearia duo
larga, Stiis vel 4tis horis.

Form. 378. Mistura Cathartica.
R Olei Cinnamomi, Tllviij. ; Sacchari Puriticati, fss. Misce.
Adde gradatim Infusi Sennie ('onip., Jx. ; Sodie Sul-
phatis, ?jss. ; Magnes. Sulphatis, jj. ; Tinct. .lalapa;,
3j. ; Tinct. Senna; Conip., 5JSS. Mfsce. Fiat Mistura,
et per chartain cola. Dosis Jjss. ad 31J.

Form. 379. Mistura Cathartica Ammoniata.
R Olei Mentha; Viridis, ?llx. ; Olei Mentha; Pipcritje, Tllv. ;
Sacchari Purificati, 5iij. Misce ; turn adde Infusi
Senna; Conip., 5vij. ; Soda; Sulphatis, 5j. ; Tmct. SeniiiE,
Jv. ; SpirilCis Animon. Aroniat., Jiij. Misce. Fiat
Mistura, cujus sumat partem 4tam, Stirs horis, duaec
alvus respondent.

Form. 380. Mistura Cinchon*.
R Cinchona; Flava; in Pulv. subactse, 3vj. ; Confectionis
Opii, jij. ; Pulv. Cinnam. Conip., 3j. ; Ammon. Ses-
quicarbon., gr. xij. ; Vini Rubri Op., 5xij. M.

Form. 381. Mistura CiNCHONiE Alkalina.
R Myrrhae in Pulv., 3jss. ; Liquoris Potassie Carbon., Jiij. ;
Decocti CinchoniB, fvss. ; Tinct. Cascarilla;, jiij. Fiat
Mist., de qual sumantur Cochlearia duo ampla, bis de
die.

Form. 382. Mistura Cinchonje Aperiens.
R Confectionis Rosse Gallics, Jj. ; contere cum Decocti

CinchoniR Ferveutis, Jviij. ; stent simul per partem

horx sextam, et cola.
R Liquoris Colati, fvij. ; Acidi Sulphuric: Diluti, 3j. ;

Magnes. Sulphatis, 3iv. ; Spiritfis Myristic*, Jss. M.

Fiat Mistura, cujus sumat Coch. ampl. iij., ter in die.

Form. 383. Mistura Conii Composita.
R Extract! Conii, 3ss. ; Sodie Carbonatis, 3ss -;. ; Decocti
Glycyrrh., fvss. ; Spirit. Pimento, 3iij. M. Dosis fss.
ad fij., ter quaterve quotidie.

Form. 384. Mistura Cret*; Comp.
R Cretae Pra;parat., Gum. Acaciie, Sacchar. Purif., Sa, fss. ;
Olei Foeniculi, lllviij. ; Aq. Pimentie et Aq. Cinnam.,
^) S^'i'j- > Tinct. Aurantii, f j. M.

Form. 385. Mistura Decocti Cincho.\*; Ammoniata.
R Decocti CinchonK, fiv. ; Liq. Animon. Acet., ^jss. ;

Spirit. Amnion. Aroiiiat. (vel Frptid., vel Tinct. Aniinon.

Compos.), 3iij. ; Spirit. Rorismarini, 31J. M. Fiat

Mistura.

Form. 386. Mistura Decocti Cinchonje Compo-
sita. (1.)
ft Decocti Cinchonae, jiv. ; Liq. Ammon. Acetatis, f ij. ;
Spirit. ..Ether. Nit., 3ij. M. Fiat Mistura.

Form. 387. Mistura Decocti Cinchona Compo-
sita. (2.)
R Pulv. Cort. CinchoniB, 3vj. ; decoque cum Aq. Fontan.,
^xvj.,ad iincias octo ; et sub fiiiem coctionis adde Pulv.
liadicis Serpentarite, 3iij. ; Pulv. Radicis Rhei Opt.,
3JSS. Culacum express. ; deinde admisce Liquoris Am-
nion. Acet., f ij. ; Sirupi Cort. Aurantii, 5J. Misce.
Capiat a:ger, alter4 quaque horik, Cochleare uuum.

Form. 388. Mistura Decocti Cinchonje cum Aceto

PVBOLIGNEO.

R Decocti Cinchonx, jvjss. ; Acidi Acetici Fortior. (vel e
Ligno destil.), 3ij. ; Spirit. Rorismarini, Spirit. Pi-
meuta;, 8&, 3ij. M. Fiat Mistura.

Form. 389. Mistura Demulcens.
R Pulveris Tragacanth., gr. xv. ; Sacchari Albi, gr. xij.
Tere, et paulatim adde Mist. Amytrdal. Dulc, fij. ;
Misi. Camphors, fiijss. ; Sirupi AlthseE, 3«s M.
Fiat Mist.

Form. 390. Mistura Deobstruens. (1.)
ft Extr. Taraxaci, Extr. Ilumuli, i&, 3ij. ; Potassa; Tarta
ri/atK', 3j. ; Aq. Fo-niculi, fvj. ; Villi Aiitiuionii Potas
sio-Tartratis, 31J.; Oxymel. Scillie, 5S8. M. Fiat Mist.,
cujus capiat Coch. j. vel ij., 3tiis vel 4tjs horis.

Form. 391. Mistura Deobstruens. (2.)
ft Radicis Rhei, fss. ; Ful. Senna;, 3ilj.; Aq. Ferv., fxij.

Infunde per huras iij., ct cola.
R IIujus Infusi, fx. ; Extracti Taraxaci, Ext. Chelid., Si,
3iij. ; Ext. Flor. Calendul., 3ij. ; Acet. Potassa;, 3vj. ;
Tinct. Caluniba;, Jss. ; Spirit. .lunip. Co., 5]. ; ./Etheris
Hydrochlorici, 3jss. M. Capiat Cochlear, j. vel ij.,
laraa, ter de die. (In Glandular Enlargements, par-
ticularly those of the Abdomen.)

Form. 392. Mistura Deobstruens. (3.)
R Extr. Taraxaci, 3ijss.; Ext. .Sarzae vel Scoparii, 3ij. ;
Potassa; Tart., 3jss. ; Bi-boralis Sodie, 3ss. , Aq. Fce-
niculi Dul., fvj. ; Vini Antimon. Pot. -Tart., 3ij. ; Oxy-
Scillae, fj. M. Capiat Coch. ij.-iij., 3tiis vel 4tis
horis.

Form. 393. Mistura Diaphoretica.
ft Liquoris Amnion. Acetatis, fiv. ; Vini Antimonii Pnt.-
Tart., Jss. ; Vini Ipecac, 31J. ; Sirupi Papaveris, Jss. ;
Aq. Destil., fxv. Misce. (Dosis a 3j. ad 5J., Stiis,
4tis, vel 6tis horis. Interdum adde, vel Spiritum^the-
ris Nitrici. vel Tincturam Opii.)

Form. 394. Mistura Diaphoretica Anodtna.
R Liquoris Ammon. Acetatis, fiv. ; Vini Antimonii Pot.-
Tart., Vini Ipecac, aa, 3ij. ; SpiritOs .Stheris Nitrici,
5ss. ; Sirupi Papaveris, jj. ; Extracti Conii, gr. xiv. ;
Aq. Destil., Jxij. Misce.

Form. 395. Mistura Digitalis et Colchici Comp.

ft Infusi Digitalis, Liq. Ammon. Acetatis, 3S, jijss. ; Po-
lassse Acetatis, 3ij. ; Aceti Colchici, 31J. ; Opii Tinct.,
Tllxx. Fiat Mist., cujus sumantur Coch. ij., larga, bis
terve in die.

Form. 396. Mistura Diosm.k CBENATiE.
ft Infusi Diosmse Crenat«, f vjss. (F. 231) ; Pulv. Traga-
canth., 3ij. ; Tinct. Diosms Crenatae, fss. M. (lu
Rheumatism, and Affections of the Mucous Surfaces,
particularly those of the Urinary Organs.)

Form. 397. Mistura Diubetica. (1.)
ft Antimon. Pot. -Tart., gr. j. : Potassa; Bitart., 3js3. ; Bi-
boratis Sods, 3ss. ; Infusi Juniperi, Jxijss. ; Spirit.
jElher. Nit., 3iij. ; Tinct. Opii Conip., Tllxxvj. ad L.
M. Capiat Coch. j. larg. 2da quaque horA. (Altered
from AuGUSTiN.)

Form. 398. Mistura Diuretica. (2.)
ft Potassae Bitait., 3ij. ; Bi-boratis Sodae, 3j. ; Aq. Fosniculi,
3viij. ; Spirit, junip. Comp. et Spirit, .^ther. Nit., 55,
3iij. i Sirup. Papaveris, Jss.

Form. 399. Mistura Diubetica. (3.)
R Baccarum Juniperi contus., 3vj. ; Carui Semin. contus.,
3iijss. ; Anisi Seiniii. cont., 3jss. ; Aq. Ferveutis, Oj.
Maceia per horas tres, et cola,
ft Liquoris Colati, 3'xij. ; SpiritOs Juniperi Corapositi. |ij. ;
Potassa; Nitratis, 3ij. : Sirupi Scilla;, Jsa. Fiat Mis-
tura, de qua sumatur Cyathus subiiid^.

Form. 400. Mistura Diuretica. (4.)
ft Infusi Digitalis, Aq. Anetlii, aa, Jiijss. ; Potassa Acetatis,
3ijss. ; Scilla; Aceti (vel Acet. Colchici), 3iij. ; Tinct.
Opii, Hlx. Fiat Mist.,cujas capiat Cochlear, ij., larga,
bis terve quotidie.

Form. 401. Mistura Diuretica. (5.)
R Gum. Acaciae. 3v. ; Saponis Med., Jss. ; Carbonatis Po-
tassie, 31J. ; Potassa; Nitratis, 3ij. ; Infusi Juniperi,
Ibij. (In Gout, with double its quantity of Potash, and
a stomachic Tincture, and the Wine or Tincture of
Colchicum.)

Form. 402. Mistura Emetica excitans. (I.)
ft Zinci Sulphatis, 3ij. ; Aq. Menth. Pip., Jivss. Solve, et
adde Vini Ipecac. Tinct. Serpentaria;, 5a, 5ss. ; Tinct.
Capsici, 3ij. ; Olei Anthemidis, Tlliii. Misce ; et fiat
Mist., cujus capiat partem tertiam vel quartam, inter-
vallis brevtbus.

Form. 403. Mistuba Emetica excitans. (2.)
ft Antimon. Pot. -Tart., gr. xij. ; solve in Aq. Menth. Piper.,
5ivss. ; et adde Vini Ipecacuanha, Tinct. Serpentariae,
5a,, 3SS. ; Tinct. Capsici, 3ij. ; Olei Anlhemidis, Tlliij.
M. Capiat partem quartam vel tertiaiii, intervallis bre-
vibos, ad affectum plenum.

XVIU

APPENDIX OF FORMULA— MisTURA.

Form. 404. Mistura E.xpectorans.
B; Mistnrae Amygdal. Dulc, 5V. ; Vini Ipecacuan., Tinct.
Scillae, aa, Jj. ; Sirujii Tolutani, 3vj. Misce. Sumat
Cochleare magnum, urgente Tussi. (In Humoral Asth-
ma, aud the latter Stage of Catarrh.)

Form. 405. Mistura Febrifuga. (1.)
B Camphoric, 3j. ; Pulv. Gum. AcaciiE, 3j. ; Mist. Amyg-
dal. Dulc, 5iij. ; Potassie Nitratis, ^j. ad Jij. ; Aq.
Flor. Sambuci Nig., fiv. ; Sirupi Papav. Albi (vel
Sir. Limonis), fss. M. Capiat fss.-fj., 3tiis vel 4tis
horis.

Form. 406. Mistura Febrifuga. (2.)
R Mist. Camphorae, 5xxiij. ; Antimonii Pot.-Tart., gr. iij. ;
PotassiB Nitratis, ^vj. ; SpiritOs ^theris Nilrici, fss. ;
Sirupi Limonum, ^ss. Misce. Interdum adde, vel
Vinum Ipecac, vel Tincturam Digitalis, vel Tincturam
Opii, vel Sirupum Papaveris.

Form. 407. Mistura Febrifuga. (3.)
B: Ammon. Hydrochlor., Succi Glycyrrh. Inspiss., aa, 5j. ;
Aq. Font , f V. Solve, et adde Vini Antimonii Pot.-
Tart., 3 ij. ; Oxymel. Sciila;, fss. M. (Heckek.)

Form. 408. Mistura Febrifuga. (Petsson.)

ft Antimonii Polassio-Tartratis, gr. j. ; Gum. Tragacanth.,
3). ; Aq. Communis, fvij. ; Tmct. Opii, Itlxx. ; Sirupi
Papaveris, 3vij. M.

Form. 409. Mistura Febrifuga Nervina.
B; Camphors rasae, 3j.-3ij. ; Vitel. Ovor., q. s. Subige,
et adde Decocti Cinohonae, f vijss. ; Tinct. Opii Comp.
(vide Form.), 3ss. ; jEther. Sulphur., 3iij. M. Capiat
fss.-fjss., 5tis vel Otis horis.

Form. 410. Mistura Guaiaci Ammoniata.
R Guaiaci Gummi Resinae, Pulveris Acaciae, aa, 3ij. ; De-
cocti Glycyrrh., Oss. ; Liquoris Ammon. Sesquicarbo-
natis, 3ijss. Tere Guaiacum et Pulv. Acaciie cum Li-
quore Ammon., et gradatim adde Decoctum.

Form. 411. Mistura Guaiaci Comp.
R Gum. Guaiaci, Gum. Ammoniaci, Gum. Acacis, aa, 3ij. ;
solve terendo in Aq. Fceniculi, fvjss., et adde Vini An-
timonii Potassio-Tartratis, f ss. ; Sirupi Althaea, 3vj.
M. Capiat Cochleare unum amplum tertiis vel quartis
horis.

Form. 4.12. Mistura cum Hydrargyri Bichlorido.
R Decocti Glycyrrh., f v. ; Aq. Cinnamomi, fij. ; Liquoris
Hydrargyri Bichloridi (Form. 322), Sirupi Aurantii, aa,
fss. Misce. Fiat Mistura, cujus sumat Coch. ampl.
ij. vel iij., statim post cibum, bis terve in die.
(Spbague.)

Form. 413. Mistura Infusi Cuspari* Composita.

R Cuspariae Corticis contus., f j. ; Aurantii Corticis exsic-
ca. i, 5ss. ; Aq. Fervenlis Uctarinm, j. Macera par ho-
ras quatuor in vase clanso, et cola.

R Infusi Colati, f vij. ; Tinct. Cinnamomi, Sirupi Auranti-
orum, aa, fss. ; Crets Pripparatce, 3j. M. Fiat Mis-
tura, de qua sumatur Cyathus (Cochlearia iij.-iv.), ter
vel quater quotidie.

Form. 414. Mistura Infusi Salicis Comp.

R Cort. Salicis contusi, 5iij-; Aquae, Oij. Decoque ad oc-
tariuni, j. ; dein adde Caryophyl. contus., 3ss., et cola.

R Liquoris Colati, Jvij. ; Tinct. Aurantii, 3vj. ; Sirupi Au-
rantii, 3ij. M. Sumat quartam partem ter die.

Form. 415. Mistura Infusi Seneg^e Comp.
ft Rad. Polyg- SenegiB cone. ; Rad. Glycyrrh., aa, f ss.
Decoque cum A(i. Fontan*, xvj., ai uiicias octo. In
colat. dissolve Ammon. Hydrochlor., 3ij. ; Pulpa; Ta-
marind., 3j. ; Antimonii Potassio-Tart., gr. j. ; Sirupi
Althaeec, 5]. M. Capiat leger, alter^ quaque hora,
Cochleare unum.

Form. 416. Mistura Infusi SERPENTARia Comp. (1.)
ft Olei Cinnamomi, TUvj. ; Sacchari Purif., 3iij. ; torantur

bcn(;,et adde Infusi Serpentarise (F. 262), 5^'j- ! Spirit.

.(Etbcris Hydrochlorici, 555. ; Tinct Capsici, 5ss. M.

Fiat Mist., cujus capiat Coch. ij.-iv., tertiis vel quartis

horis.

Form. 417. Mistura Infusi Serpentajii/e Comp. (2.)
ft Infusi Serpentaria;, ?vj. ; Tinct. Camjih. Comp., 3v. ;

Spirit. Amnion. Arom., 3ij. ; Sirupi Aurantii, fj. M.

(Capiat partem quartam tertiis vel quartis horis.

Form. 418. Mistura Infusi Vvje Ursi.
ft Infusi I'vae Ursi, 3xiv. ; Potassae Bicarbon., gr. xx. ; Ex-
tracti Conii, gr. iij. ad gr. vj. ; Extiacti Papaveris, gr.

V. ad viij. ; Sirupi Zingiberis, 3ij. M. Fiat Hanstus,
ter in die sumendus.

Form. 419. Mistura Infusi Vvm Ursi Composita.

R UviE Ursi Fol., 3ijss. ; Radicis Rhei concis. et cont., 3j. ,
Aq. Ferventis, fxij. Macera per horas ij., in vase
clauso, deinde cola.

R Liquoris Colati, Jvijss. ; Sodae Carbon., 3jss. ; Tinct.
Opii, lllilv. (vel Ilyoscyami, 3jss.) ; Tinct. Camphorae
Comp., 3iij. ; Sirupi Tolutani, 3jss. M. Fiat Mist.,
cujus capiat Cochlearia duo magna, quatuor vices in
die.

Form. 420. Mistura Laxans.

R Infusi Rosae Com., Jvjss. ; Acidi Sulphur. Dil., Tllxi. ,
Potassae Sulphatis, 3iij. ; Tinct. Aurantii Comp., 3iij.
M. Fiat Mist., cujus capiat Cochlearia ij., larga, ter-
tiis vel quartis horis.

Form. 421. Mistura Mucilaginis Anodyna.
ft Mucilaginis Tragacanth., Jijss. ; Oxymellis Scillae, 5ss-;
Sirupi Papaveris, pj. Misce. Fiat Mistura. Coch-
leare amplum, urgenti Tusse, gradatim deglutienduni.
(If the mucilage of Tragacanth should not be at hand,
its place may be supplied by Pulvis Tragacanth. Comp.,
3jss. ; Aq. Destil., fijss. Sprague.)

Form. 422. Mistura Myreh^e.
ft Myrrhae, 3jss. ; Decocti Glycyrrh. Ferventis, ?vss. Si-
iiiul tere, et cola. Dosis jj., bis vel ter quotidit. Sin-
gulis dosibus interdum adde, Sodae Carbonalis, gr. xij.,
vel Acidi Sulphurici Aromatici minim, xv., vel Tinct.
Camphors Comp., 3ss. Misce. (In the latter stages
of Phthisis Pulinonalis, when languor or debility is a
very prominent symptom, the above mixture, combined
according to circumstances, is an excellent medicine.)

Form. 423. Mistura Nervina. (1.)
ft Mist. Camphorae, f iij. ; Mist. Asafeetidae, ^ij. ; Tinct.
Valerianae, Tinct. Ammon. Compos., Spiritus JEtheris
Sulph. Compos., aa, 3ij. M. Fiat Mistura, cujus su-
mantur Cochlearia duo ampla subinde.

Form. 424. Mistura Nervina. (2.)
R Mist. Camphorae, Jvij. ; Spiritus ^Etheris Sulphurici
Comp., Tinct. Ammon. Compos., aa, 3ijss. ; Sirupi
Croci, 5ss. Fiat Mistura, de qua sumantur Cochlearia
duo vel tria magna, urgente Agitatione.

Form. 425. Mistura Oieosa.
R Olei Olivffi (vel Olei Lini), Aq. Pimentae, aa, Ojss. ; Po-
tassie Carbonatis, 3vj. Misce. Dosis 5j. ad 5jss. An-
tiphlogista fit addendo Liqnoris Antimonii Pot.-Tart.,
5SS. ad f ij. Anodyna fit addendo Tinct. Opii, 3j. ad ?j.
Volatilis fit usu Spiritus Ammon. AromaJici loco Po-
tassie Carbonatis.

Form. 426. Mistura Pectoralis. (I.)
R Rad. Althaeae, ^jss. ; Semin. Anisi cont., 3iij. ; Aq. Fer-
vent., q. s., ut sit Cnlat., ?xij. Adde Ammon. Hydro-
chlor., 3ij.; Succi lusp. (Slycyrrh., fss. M. (AUST.
Phar.)

Form. 427. Mistura Pectoralis. (2.)
R Decocti Cetrariae, f xj. ; Vini Ipecac, 3ij. ; Extr. Conii,
3j. ; Olei Anisi, Hlxij. : Sirupi Althaeie et Sirupi Pa-
paveris, aa, 3iij. M. Capiat Coch. iij. vel iv., quater
in die.

Form. 428. Mistura Phosphorata.
R Phosphori, gr. ij. ; Olei Terebinth., 35s.; Olei Olivse,
3ijss. ; Mucilag. Acaciie, 5j. ; Aq. Anethi, Jiv. ; Sirupi
Zingiberis, f j. ; Olei Caryophyl., Tllvj.

Form. 429. Mistura Purgans. (1.)
R Infusi Sennae Comp., Jivss. ; Magnes. Snlphatis, 5j- ,
Aq. Menth. Sativ., Jijss. ; Tinct. Sennie Comp., fss.
M. Sumantur Cochlearia iv., priino mane, et repetau-
tur post hol-as tres, si opus sit.

Form. 430. Mistura Purgans. (2.)
ft Fol. Sennae, Conservac Menth. Viridis (F. 49), 58, fss. ;

Sem. Coriand. contus., 3ij. ; Aq. Ferventis, f viij. Ma

cera per horas duas, et cola.
R Infusi supra pra^scripti, Jvij. ; Sodffl Sulphatis, 5J. ; Tinct

Sennae Comp., 3vj.; Tinct. Cardam. Co., 3ij. ; Sp.

Ammon. Arom., 3ij. M. Ft. Mistura. Capiat partem

4tam secnndis horis, donee bene solutus sit alvus, el

pro re natd repetatur.

Form. 431. Mistura Refrigerans.
ft Camphorie rasae, gr. x.-3j. ; tere cum Mucilaginis
AcacisE, 3iij. ; Ammon. Hydrochlor., 3J.-3JSS. ; Aq
Flor. Aurantii, Aq. Com., aa, Jiij. ; Sirupi Aurantii>
Jss. M.

APPENDIX OF FORMULA.— MisTURA—PiLui,^.

XIX

Form. 432. Mistura Uesolvens.
R Flor. ArnicoD, 3jss. ; Aq. Fervid., q. s., ut sint Colaturie,
Jvijss. Adile Potass^ Carbon., 3j. ; Tiiict. Lavandul.
Co., 3jss. M. (In Engorgements of Glands, <tc.)

Form. 433. Mistura Rhei Composita.
B; Rhei Radicis contrit., 5ss. ; Sodte Carbonatis, 3j. ; De-
rocti Glycyrrh., 5v. el Jij. ; Tinct. Aurantii, 3vj. Misce.
Uosis d 3SS. ad jj., semel, bis, vel ter quotidi^. (This
is a pleasant and etficacious method of administering
small doses of Khubarb in Dyspepsia.— SpRAOUE.)

Form. 434. Mistura Rhodu Comp. (1.)
R Tinct. Rhodii, 3iij. ; Mucil. Acaoise, 3vj. Tcrantur probe
simul ; adde gradatim, Infusi Caryophyllorum, Jiv. ;
Sirupi Zingiberis, 3ss. M. Fiat Mistura. Sumat par-
tem 4tam ter in die, urgente Flatu.

Form. 435. Mi4tura Rhodii Comp. (2.)
R Tinct. Rhodii, jss. ; Mucil. Acacia;, 3vj. Tere bene, et
adde gradatim, Infusi Uvs Ursi, Jvj. ; Sirupi Papave-
ris, 3vj. M. Fiat Mistura. Dosis partem 4tam, ter
quaterve in die. (In Asthma, and in Chronic Ca-
tarrhs, &c.)

Form. 436. Mistura Salina.
R Mist. Camphor;e., Jivss. ; Liq. Ammon. Acet., 3iij. ;
Spirit. .iEther. Nit., 3iij. ;.PotassiE Nit., 3ij.; Sirupi
Limonis, 3ij. M. Fiat Mist., cujus capiat Cochlearia
ij., larga, quarts quaque hor&.

Form. 437. Mistura Sauna Antiseptica. (1.)

R Infusi (vel Decocti) Cinchonae, 5vij. ; Sodii Chloridi,
3j.-3ij. ; Potassae Chloratis, 3SS.-3J. Solve, et adde
Tinct. Serpentariifi, 3SS. M.

Form. 438. Mistura Salina Antiseptica. (2.)
R Infusi (vel Decocti) CinchoniE, Mist. Camphor., aa, 5'ijss. ;
Potassae Nitratis, Potassse Chloratis, aa, 3ij. ; Tinct.
Serpentaria;, 3SS. M.

Form. 439. Mistura Salina Antiseptica. (3.)
R Mist. Camphor., fvij. ; Potasss Chloratis, 3ij. ; Sodii
Chlorid., 3j. ; Tinct. Serpentaria, Jss. ; Spirit. Lavand.,
3ij. M.

Form. 440. Mistura Salina Febrifuoa. (1.)
R Mist. Camphorae, 5ivss. ; Liq. Ainmon. Acet., f ijss. ;
Magncs. Sulphatis, 3SS.-3J. (velPotassiE Sulph., 3ij5s.) ;
Spirit. jElher. Nit., 3iij. M.

Form. 441. Mistura Salina Febrifuoa. (2.)
R Mist. Camphoric, Jivss. ; Liq. Ammon. Acet., f iij. ; Sodae
Sulphatis (vel Sodae Phosphatis), 3vj. ; Spirit. .iEther.
Nitrici, 3iij. M.

Form. 442. Mistura Sedativa.
R Magnes. Carbonatis, Cretae Prsparatae, Pulv. Acaciae, a5,
31J. ; Spiritfls Ammon. Aromat , 3ijss. ; Tinct. Asafoe-
tidae, 3iij. ; Sirupi Papaveris, ?ss. ; Aq. Destil., Oj.
Misce. Dosis a J^^s- ad Jjss., 3tiis, vel 4tis, vel 6tis
horis. Interdum adde Tinct. (iatechu, <fec., &c.

Form. 443. Mistura Strychnia.
R Strychniae Purissimae, gr. j. ; Sacchari Purif., 3jss. ; Aq.
Destil., fij. ; Acidi Acetici, gtt. ij. M. Capiat (ioch-
learia minima ij., mane nocteque.

Form. 444. Mist. Terebinthinje Venetj!. (Clossius.)
R Terebinth. Venet., 3j.-3jss. ; Vitelli Ovorum, q. s. ; et
adde Aq. Menth. Piperita;, fivss. Capiat Cochleare j.
7el ij., pro re nata. (Against Worms and Chronic Af-
fections of the Mucous Surfaces.)

Form. 445. Mistura Tonica. (1.)
R Infusi Cascarilla; (vel GentianiJB Comp.), f vij. ; Potassae
Carb., 3j.-3jss. ; Tinct. Aurantii Comp., Spirit. Pi-
ments, Sa, 311J. M.

Form. 446. Mistura Tonica. (2.)
R Infusi Cascarillae, Ojss. ; Acidi Sulphuric! Aromat., 3ij.
Misce. Dosis i Cochlear, ij., parv. ad Cochl. iij., mag-
na, bis die.

Form. 447. Mistura Vermifuoa.
R Rad. Valer. Min., Semin. Santon., aa, fss. Infunde Aq.
Font. Fervid., fviij. ; digcre per horam, dein cola.
Liq. colato adde Asafoetidae, 3j., in Viteli. Ovi solutE.
Fiat Mistura.

Form. 448. Mistura Vinosa.
R Vini, fvj. ; Ovorum duorum Vitellos ; Sacchari Puri-
ticat., fss. ; Olei Cinnamom., TI1,iv. ; Tinct. Capsici,
3j. M. Dosis 3jss.. ter quaterve, aut sKpius, quo-
tidi6, urgentibus Languoribus.

II 13

Form. 449. Oleum Camphors.
R Acidi Nitrici quantum velis ; CamphorsE, q. s., ad Aci-
dum saturundum. Scrva in vase bene obturato. (Fee.)

Form. 450. Pilul* Aloes cum Ferro.
R Aloes Spicali Extracti, 3jss. ; Myrrha; Gummi Resin,
pulv., 3ij. ; Extracti Gentianie, 3iv. ; Ferri Sulphatis,
3ij. ; Theriacac I'urificat., q. s. Simul contuiide, eC
in Pilulas cxx., divide. Dosis & ij. ad iv., semel vel bis
quotidie.

Form. 451. PiLULiE Aloes cum Ferro Composit*.
R Masste Pilul. Aloes cum Myrrha, Pilul. Ferri Comp., Pi-
lul. Galban. Comp., 53, 3ij. ; Sods Carbon, exsic,
3j. ; Olei Junip. Sabin., Uliv. Contunde simul, et fial
massa a^qualis, in Pilulas xxx., distribueuda. Capiat
a;gra binas, mane nocteque.

Form. 452. Pilul/e Aloes et Ferri.
R Ferri Sulphatis, PotassK Carbonat., aa, 3j. ; Myrrho
pulver., 3j. ; Aloes pulver., 3ss. M., et divide in Pi-
lulas xxx. Capiat ij. vel iij., node maneque.

Form. 453. Pilule Aloes et Moschi Composite.
R Pilul. Aloes cum Myrrhft, 3j. ; Camph. rasae, gr. xij. ;
Moschi, gr. xxviij. ; Balsami Peruvian], q. s. M. Fiant
Pilul. xxiv., quarum capiat binas omni nocte.

Form. 454. PiLUL* Aloes et Scammoni* Comp.
R Aloes Spicat., 3j. ; Scammon., gr. xij. ; Extr. Rhei,
3ijss. ; Baccar. Capsici pulv., gr. viij. ; Olei Caryoph.,
Ttlvj. M. Fiant Pilul. xviij., quarum sumantur bina
hork decubitOs.

Form. 455. Pu.ULi: Alterativje. (1.)
R Massffl Pilul. Hydrarg. Chloridi Comp., 3ij. ; Saponi.^
Caslil., 3ss. ; Extr. Sarzse et Extr. Taraxaci, aS, 3J8S.
Misce bene, et divide in Pilulas Ix., quarum capiat bi-
nas vel tres, ter quotidie.

Form. 456. PiluljE Ai.TERATiViE. (2.)
R Scillae Radicis exsic, gr. vj. ; Pulv. Fol. Digitalis, gr.
xij. ; Hydrarg. Chloridi, gr. vj. ; Myrrhie Pulv., 3j.
Tere simul, et adde Asafu^tid., 3ss. ; Extr. Gentian.,
q. s. Fiat massa a;qualis, et divide in Pil. xviij., qua-
rum capiat unam maiie, meridie, et nocte.

Form. 457. PiluL/E Ammoniaci Composit.e
R Gummi Ammoniaci, 3j. ; Saponis Castil., Fellis Bov. In-
spissat., Pilul. Hydrarg., Pulv. Folior. Conii, Extracti
Conii, aa, 3ss. ; Ext. Taraxaci, Jij. ; Antiitionii Oxy-
sulphureti, 3j. ; Theriac* Purif., q. s. Cimtunde in
massam aequalem, et divide in Pilulas Ixxx., quarum
capiat binas vel tres, ter quolidii. (De)bstruent, dis-
solvent, &c.)

Form. 458. Pilule AMMONiiE et Anthemidis.
R Ammon. Sesquicarbonatis Pulver., Extracti Anthemidis,
aa, 3ss. Fiat massa, in Pilulas xij., dividenda, quarum
sumatur una bis vel ter die.

Form. 4.59. PiLUL;E Ammonio-Sulphatis Cupri Comp.

R Cupri Ammonio-Sulphatis, Oxydi Zinci, 35, gr. vj.-xij. ;
Sacchari Albi, Pulv. Tragacanth., 35, gr. xij.; Muci-
lag. Acaciffi, q. s., ut fiant Pilul. xij., quarum capiat
unam bis terve quotidie. (Epilepsy, Chorea, <fec.)

Form. 460. Pilul^e Anodyn.e.
R Camph. rasae, gr. ij.-vij. ; Potassae Nitratis, gr. v.-viij. ;
Extr. Hyoscyami, gr. iij.-gr. viij. ; Sir. Papaveris, q. s.
Misce. Fiant Pilul. iij.-vj., h. s. sumendie.

Form. 461. Massa Pilularum Anodynarum.
R Opii Crudi in Pulv. subtiliss., 3ss. ; Extracti Hyoscyami,
jijss. ; Saponis Duri, Iridis Flor. pulv., 33, jj. Con-
tunde, ut tiat massa, in Pilulas sexaginta aequales dis-
tribuenda.

(Ten grains of the mass contain one grain of opium
and five of the extract of henbane.)

Form. 462. PiluljE Anodyno-Aperientes. (1.)
R Pulv. Ipecac, gr. x. ; Extracti Colocynthidis Comp., 3j. ;
Extracti Hyoscyami, 3ss. ; Pilul. Hydrarg., 3j. , Sa-
ponis Castil., gr. X. ; Olei Caryoph., Illiij. Contunde
in massam aequalem, et divide in Pilulas xxx., quarum
capiat unam, duas, vel tres pro dose.

Form. 463. PiLULiE Anodyno-Aperientes. (2.)
R Pulv. Ipecac, gr. viij. ; Extr. Colocynth. Comp., 3ijss. ;
Extr. Hyoscyami, 3ss. ; Fellis Taur. Inspiss. Con-
tunde simul, et divide massam in Pilulas xxiv., quarum
capiat unam, duas, vel tres pro dose.

Form. 464. PiluljE Antimonii Alterativ.*.
R Antimonii Oxysulphureti, 3j. ; Florum Sulphuris, 31J. ;

APPENDIX OF FORMUL-^.— Pilule.

Camph. rasae, 3j. ; Extracti Taraxaci (vel Extr. Sarzae),

3iijss. Fiat massa aequalis, et divide in Pilulas icv.

Capiat duas vel tres, ter quotidi^.
Fonn.465. Pilvl* Antimonii et Guaiaci Composite,
R Antimonii Oxysulphureti, 3j. ; Florum Sulphur., 3iij. ;

Resin. Guaiaci, Extr. Conii, 5a, 31J. ; Sirupi Althiea;,

q. s. Fiat massa aequalis, et divide in Pilulas cxx.

Capiat binas vel ires ter die.
Fonn. 466, Pit. Antimonii Oxysulphureti Coiwp, (1.)
R Antimonii Oxysulphureti, gr. v. ; Pilul, Hydrarg., Ex-

irarti Hyoscyami, aa, 3j. Misce ut fiat massa aequalis

in Pilulas decern dividenda, quarum sumatur una ter

die.
Form. 467. Pil. Antimonii Oxtsvlphureti Comp. (2.)
R Antimonii Oxysulphureti, Hydrargyri Chloridi, Sa, gr.

ss. ; Extracti Conii, gr. iv. Fiat Pilula ter die su-

inenda.

Form. 468. Pilul* Antispasmodic*.
R Gum. Ammoniaci, 3j. ; Benzoini, Pulv. Myrrh-<e,aa, 3ij. ;

AsaffEtida;, jss. ; Camphorae, 3j. ; Tiuct. Opii, Tllxij.

Misce. Divide in Pilulas Ix., quarum capiat aeger,

onini trihorio, duas vel tres.

Form. 469. PiLULiE Antispasmodice Pierquikii.
R Camph., Potassae Nitratis, Pulv. Digitalis Purpur., aa,
3ss. ; Pulv. Cinchonae Fiav., jj. ; Extracti Gentianae,
3ij. ; Sirup. Simp., q. s. M. Fiant Pilul. Ixx.

Form. 470. PiLULiE Aperientes Comp.

R Pilul. Hydrarg., Pilul. Aloes cum Myrrha, aa, 3j. ; Pi-
lul. Cambog. Comp., gr. xvj. ; Pulv. Mastiches, gr. vj. ;
Olei Caryophyl., tiliij. M. Fiat massa aequalis, et di-
vide in Pilulas xxiv., quarum capiat liinas hor4 somni
quotidie.
Form. 471. Pilule Aperientes Alterative.

R Pilul. Hydrarg., 3j. ; Antimonii Pot. -Tart., gr. jss. ;
Extr. Jalapae, 3jss. ; Feliis Tauri inspissati, 3ss. ; Sa-
ponis Castil., gr. xv. Contunde in massam aequalem,
et divide in Pilulas xl. ; quarum capiat biuas vel tres
cmni nocte.

Form. 472. Pil. Argenti Nitratis et Belladonna.

R Argenti Nitratis palv., gr. ij.-iv. ; Pulv. Radicis Bella-
dnnnae, 3j. ; Extr. Glycyrrh., 3j. Misce bene, et di-
vide in Pilulas xxxvj. ; quarum capiat unara ad ires,
bis terve quotidi^. (In Pertussis aud Epilepsy. M.

BORIF.S.)

Form. 473. PiLULiE Argenti Nitratis Composite;.
R Nitratis Argenti pulv., gr. v. ; Opii Puri, gr. x. ; Camph.
rasa?, Nucis Myrislicae, aa, 3jss. ; Pulv. Acaciae, 3ss. ;
Sirujii Simp., q. s. M. Divide in Pilulas xxxvj., qua-
rum capiat unam ad tres, bis terve quotidie.

Form. 474. Pilul* Argenti Nitratis et Gentian*.

R Argenti Nitratis, gr. ix. ; Opii Puri, gr. v. ; Extr. Gen-
tianae, Extr. Glycyrrh., aa, 3jss. Divide in Pilulas Iv.,
quarum capiat unam ad tres vel quatuor, bis terve quo-
tidie. (Niemann.)
Form. 475. PiLUL* Argenti Nitratis Opiat*.

R Argenti Nitratis pulv., gr. x. ; Moschi, 3j. ; Opii, 3jss. ;
Camphora, 3ij. ; Pulv. Acacia:, 3ss. ; Sirupi Simp., q.
s. Misce bene, et divide in Pilulas Ixxx., quarum ca-
piat unam ad quatuor bis terve quotidie. (Van Mons,
Cadet de Gassicourt, et Ratier.)

Form. 476. PiLUL* Arsenicales. (1.)
R Acidi Arseniosi, gr. ij. ; Opii Puri, gr. viij. ; Saponis
Medic, gr. xxxvj. Divide in Pilulas xxiv., quarum ca-
piat j.-iij., pro dose.

Form. 477. PiLUL* Arsenicales. (2.)
R Acidi Arseniosi, gr. vj. ; Opii, gr. xij. ; Ammon. Hydro-
chlor., 3SS. ; Mucilag. Acaciie, 3ij. ; Sirupi Simp.,q. s.
M. Divide in Pilulas xxx., quarum capiat unam vel bi-
iias ter die.

Form. 478. Pilul* Arsenitis Ferri. (Biett.)
R Proto-Arscnitis Ferri, gr. iij. ; Extr. Humuli, 3ij. ; Pulv.
Althaea;, 3ss. ; Sirupi Auran., q. s. M. Divide in Pi-
lulas xlviij., quarum capiat unam in die.

Form. 479. Pilul* Asafcetid* cum Cinchona.
R AsaffRtid^ Giimmi RcsiniK, 3j. ; Extracti Cinchnnae Opt.,
31J. ; Saponis Duri, 3ss. ; Olei Pulegii, Tllxij. ; Theriac.
Purificat.,q. s., ut fiat massa ; in Pilulas xlviij. divide ;
ijuarum capiat iij. vel iv., nocte niaivcque.

Form. 480. Pilul* Asafcetid* Cqmposit*.
R ABafalid., Castorei, Valeriana, Succini, ii, pulveriz.,

Jss. ; Camphorae, gr. i. ; Olei Cajpputi, q. s. M. Fiant
Pilul. xxxvj., quaram capiat binas pro dose.

Form. 481. Pilul* Asafcetid* cum Felle.
ft AsafcElida;, Feliis Tauri inspissati, Sa, 3j. ; Pulv. Rhei,
3j. ; Sirupi, q. s. M. Fiant Pilul. xl.

Form. 482. Pilul* Asafcetid* et Valerian* Comp.

R Gum. Asafcetid., Pulv. Valerianae, ii, 3j. ; Extr. Aconitj,
gr. vj. ; Pulv. Scill^e, gr. viij. ; Castorei, Jss. ; Ammon.
Sesquicarbon., gr. xvj. ; Sirupi Papaveris, q. s. M.
Fiant Pilula; xlviij., quarum capiat duas ad quatuor pru
dose. (In Spasmodic Affections of the Respiratory Or-
gans. Richter.)

Form. 483. PiLUL* Astringentes.
R Extr. Cinchonae, Ferri Ammonio-Chloridi, Aluniinae
Sulph., Pulv. Aroinat., aa, 3jss. ; Olei Caryoph., q. s.
M. Fiant Pilula Ixxxiv., quarum capiat j.-ij., pro
dose.

Form. 484. PiLUL* Balsam* Comp.

ft Myrrhae Gummi Resina; pulv., 3ij. ; Galbani, Asafoetidae,
aa, 3j. ; Capsici Annul pulv., gr. xv. ; Balsami Peni-
viani, 3j. M. Fiant Pilulae xxx. ; e quibus sumantur
binae vel tres, bis terve de die.

Form. 485. Pilul* Balsamic*. (1.)

ft Extr. Aloes, 3ij. ; Extr. Rhei, 3j. ; Balsami Peruv. et

Benzoini, aa, 3ss. ; Croci Stigmat. et Myrrhae, Sa, 3j. ;

Extr. Opii, gr. v. ; Spirit. Vini et Sirupi, q. s. Fiant

Pilulae Ixxx., quarum capiat unam ad quatuor pro dose.

Form. 486. Pilul* Balsamic*. (2.)
ft Terebinthinffi Chiensis, Spermaceti, aa, 3ij. : Pulv.
MyrrhiE, 3J. ; Olibani Pulver.,q. s.,ut fiant Pilul. Ixx.,
quarum capiat unam vel duas omni tertia vel quarld
hor4.

Form. 487. Pilul* Balsamic* Camphorat*.
ft Acidi Benzoici, 3j. ; Camphorae, Croci Stig., Balsami Pe-
ruviani, G. Ammoniaci. aa, 3). ; Mucilag. Acaciae, q. s.
M. Fiat massa, quam divide in Pilulas xxxvj., quarum
capiat binas pro dose.

Form. 468. Pilul* Belladonn*.
ft Extr. Belladonnae, gr. vj. ; Pulv. Rad. Glycyrrh., 3ss. ,
Succi Inspissati Sambuci Nig., q. s., ut fiant Pilul. xij.
Capiat unam ad tres pro dose.

Form. 489. Pilul* Benzoini etTerebinthin* Comp.

ft MyrrhiB, G. Ammoniaci, aa, 3jss. ; Benzoini, 3j. ; Extr.
Gentianae, 3ij. ; Terebinth. Venet., 3jss. ; Piilv. Rhei,
q. s. Fiat Massa asqualis, et divide m Pilulas, gr. iv.,
pond. (In Hypochondriasis, Habitual Constipation, &c.)

Form. 490. Pilul* Bismuthi.
ft Bismuthi Tris-nit., Castorei, aa, gr. j.-iij. ; Pnlv. Gly-
cyrrh. et Mellis, q. s., ut fiant Pilul. ij., tertiis vel quar-
tis horis sumendie.

Form. 491. PiLUL* Bruci*.
ft Bruciae Purae, gr. xij. ; Conserv. Rosar., 3ij. Misce bene,
et divide in Pilulas xxiv. aequales. Capiat unam ad
quatuor pro dose.

Form. 492. PiLUL* Cambogi* Composit*.
ft CambogiiE, 3j. ; solve in Olei Ricini panxillo, et adde
Pilul. Aloes cum Myrrha, Pilul. Galban. Comp., Pilul.
Hydrarg., 33, 3ij. Contunde ben^ simul, et divide in
Pilulas xlviij. Capiat unam ad tres pro dose.

Form. 493. Pilul* Camphor* et Antimonii The
baiac*.
ft Camph. rasae, gr. iv. ; Pulv. Jacob) Veri, gr. iij. ; Opii
Pun, gr. ss. ; Sirupi Simp., q. s. Fiant Pilul. ij., quar
la vel sexta quaque hora sumendae.

Form. 494. PiLUL* Camphor* Comp. (Brera.)
ft Camphorae, 3j. ; Potassae Nitratis, 3ij. ; Kermis Mine-
ralis, gr. vj. ; Pulv. Glycyrrh. et Mellis, aS, q. s. M.
Divide in Pilulas iviij., quarum capiat duas, terti^
qudque horii.

Form. 495. Pilul* Camphor* et Ipecacuanh*.
ft Pulv. Ipecac. Comp., gr. iv. ; Camph. rasae, gr. j.-iij. :
Sirupi Papaveris, q s. M. Fiant Pilul. iij., quarts
quaque hiird su mends.

Form. 496. Pilul* Camphor* et Nitri.
ft Camph. Subactae, Polassa; Nitratis, aS, gr. ij.-v. ; Con-
serv. Rosar., q. s. M. Fiant Pilul. ij. vel iij.

Form. 497. Pilul* Castorei Thebaiac*.
ft Opii, gr. ss. ; Castorei Rossici, gr. vjss. ; Pulveris Digi-

APPENDIX OF FORMUIJE— Pilule.

talis, gT. j. ; Sirupi, q. s. Fiant Pilul. duff, bis vel ter
die Kumendx. (In Spasmodic Asthma, and Dyspnoea.)

Form. 498. Pilul* Cathahtic*. (1.)
R Hydrarg. Chloridi, gr. viij. ; Extr. Res. Jalap., gr. xvj. ;
Gum. Guaiaci, gr. xxiv. : Mucilag. Acaciie, q. s. M.
Divide in Pilulas xij. Capiat binas vel tres pro re
iiat&.

Form. 499. Pilul* CATHARTiCiB. (2.)
R Cambogiffi Gum., Jjss. ; Scammon., 3j. ; solve terendo in
pauxillo Olei Junip. ; dein adde Alo^s Socot., 3ij»s. ;
Gum. Ammoniaoi, jjss. ; Potassae Sulphatis, 3j. ; Oxy-
mellis Sciliae, q. s., ut fiat massa squalis. Capiat pro
dose, gr. x. ad gr. xxx.

Form. 500. PiLUL* Colocynthidis Compositje.
R Colocynthidis Pul()iE, f ss. ; Alogs Spicat* Extracti,
Scammun. Guninii Resiiiai, 55, 5J. ; Sapnnis Duri, 3ij. ;
Olei Carj'ophylli, 3j. Alof, Scaminonia, et Colocyn-
thidis pulpa in pulverem rediganlur; turn cum Sapune
at(|uc Olec) conterantur; denique cum Mucilagine Aca-
ciie subigantur in massam.

Form. 501. Pii.uL*; Colocynthidis cum Hydrargyro.

R Masss Pil. Colocynth. Coniposit., 3iv. ; Hydrargyri Chlo-
ridi (Calomel), 3). Simul contunde in niortario lapideo,
donee niassa «qualis sit ; et in Pilulas Ix., Equales dis-
tribuenda. Dosis, ab j. ad iv., pro re natd.

Form. 502. Pilule Cupri Sulphatis cum Opio.
R Cupri Sulphatis, gr. vj. . Opii Puri, gr. iv. ; Pulv. Tra-
gacanlh. Comp., 3j. ; Mucilag. Acaciae, q. s., ut fiant
Pilul. xij. ; quarum capiat unam ter die, postea quater
quotidie, tcI tertiis aut quartis horis. (Chronic Diar-
rhoea and Dysentery.)

Form. 503. Pilul* Deobstruentes. (I.)
R Antimonii Potassio-Tartratis, gr. iv. ; Pilul. Hydrarg.,
3j. ; Saponis Castil., Gum. Ammoniaci, AsafetidiE,
Extr. Aloes Purif., aa, 3ss. Misce bene, et divide in
Pilulas lixv., quarum capiat binas ter die.

Form. 504. Pilule Deobstbuentes. (2.)
R Extr. Aquosi Aloes, 3ij.; Gum. Ammoniaci, 3ij. ; Myrrhffi,
Mastichcs, Benzoini, Rhei, 55, 3j. ; Croci Stigm., gr.
xvj. ; Potassae Carbon., 3ijss. ; Mellis,q. s., ut fiat mas-
sa squalis. Capiat gr. x. ad xx., pro re nat&.

Form. 505. Pilul* Deobstbuentes. (Barthez.) (3.)
R Kermis Mineral., gr. j. ; Hydrarg. Chloridi, gr. ij. ; Extr.

FumarisE (vel Extr. Taraxaci), gr. x. Fiant Pilul. iij.,

pro dose.

Form. 506. Pilul* Deobstbuentes. (Recamier.) (4.)

R Saponis Castil., 3ijss. ; Gum. Ammoniaci, 3j. ; AIoCs

Extr. Purif., gr. xv. ; Asafietidie, Jss. ; Pulv. Rhei, 3j. ;

Croci Sativi, 3ss. ; Sirupi, q. s. M. Fiaut Pilula

Ixxxiv., quarum capiat binas bis quotidie.

Form. 507. Pilul* Deobstbuentes. (5.)
R Saponis Hisp., 3iij.; Gum. Ammoniaci, "j. ; Aloes, 3j. ;
Rhei Pulv., 3j. ; Asafolida;, Croci, 8a, 3ss. ; Sirupi,
q. s. M. Divide in Pilulas c. Capiat biuas ad qua-
tuor, bis terve in die.

Form. 508. Pilul* Deobstruentes. (6.)
R Saponis Medicinalis, 3iv. ; Gum. Ammoniaci, 3ij. ; Ex-
tracli Conii, Extr. Aroniti Paniculati, 58, 3jss. ; Massae
Pilul. Aloijs cum MyrrhA, 3j. Contunde m massam
sequalem, et divide in Pilulas granarum quatuor. Ca-
piat biiias mane nucleque, augciido unam quotidie donee
IV. vel XX., sumantur in die. (Dr. Lowassy, in Gland-
ular Tumours and Scirrous Formations.)

Form. 509. Pilul* Deobstbuentes. (Stoll.) (7.)
R Antimonri Oxysulphureti, 3j. ; Saponis Venetii, 3ij. ;
Gumnii Acaciae, 3]- ; Mucilag. Gum. Tragacanth.,q. s.
Fiant Pilul. L. Sumat tres mane et nocte. (For Cu-
taneous Eruptions, Rheumatism, <Si;c.)

Form. 510. Pilul* Deobstbuentes. (8.)

R Hydrarg. cum Crelft, gr. xvj. ; Sods Carbon, exsic, 3j. ;
Extracti Taraxaci, 3j. M. Fiant Pilul. xx., quarum
capiat duas vel tres umni nocte.

Form. 511. PiLUL* BiNioDiDi Hydrargyri.
R Hydrarg. Biniodidi, gr. ij. ; Extr. Humuli, St}. ; Pulv.
Glycyr., q. s. Misce bene, el divide in Pilulas xvj.,
quarum <?apiat binas mane nocteque,et augeat dosiu ad
tres vel quatuor.

Form. 512. Pilul* Diaphoretic*.
R Oiydi Zinci, Extracti Aconiti. Sft, gr. xij ; Antimonii
Oxysulphureti, gr. vj. ; Extracti Humul'i, 3j. ; Sirupi

Papaveris. q. s. Contunde bene simul, et divide in
tcrliil qu&que horA. (In Chorea, Sciatica, Hysteria,
and Rheumatism.)

Form. 513. PiLUL* Diaphoretic* Sedativ*.

R Kermis Mineral., Extr. Opii, 85, gr. ij. ; Polassa; Nitra

tis, gr. v. ; Sirupi, q. s. Fiant Pilul. ij., pro dose.

Form. 514. Pilul* Digitalis et Camphor.* Comp.
R Pulveris Digitalis, gr. vj. ; Camphorte, gr. xv. ; Extracti
Hyoscyanii, 3J8s. Fiant Pilul. duodecini. Sumat tres
onini nocte. (In Maniacal and Spasmodic ABectious.)

Form. 515. Pilul* Digitalis et Myrrh* Comp.
R Myrrhu; G. R., gr. ij.-iv. ; Pulv. Digitalis, gr. j. ; Extr.
Hyoscyanii, gr. iij -v. ; Sirupi, q. s. Fiant Pilul. ij.,
bis terve quotidie suinendie.

Form. 516. Pilul* Diuretic*.
R Scillie Rad. pulver., gr. ij. ; Pulv. Foliorum Digitalis, gr.
j. ; Pilul. Ilydrargyri, gr. vj. ; (Jlibani pulver., 3ss. j
Olei Juniperi, llliv. Fiat massa in Pilulas quatuor di-
videnda, i quibus capiat ij., horil somni, su|>erbibendo
haiistulum Misturae Diureticie, No. 398, vel 399.

Form. 517. Pilul* Diuretic* Alterativ*.
R Potassa; Bitart., 3j. ; Biboratis SodiE, 3jss. ; Pulv. Rad.
Polygalie Seneg;e, 3]. ; Pulv. Radicis Colchici exsic.
3ij. ; Pulv. Scillae, gr. xvj.; Extr. Taraxaci, 3iij. Fiat
massa tequalis, et divide in Pilulas c, quarum capiat
tres, ter quotidie.

Form. 518. Pilul* Dulcamah* et Antimonii.
R Antimonii Sesqmsulphureti, Pulv. Slip. Dulcamarae, 55,
3j ; Extr. Dulcamarae, 3ij ; Sirupi Tolutani, q. s. .M.
Fiant Pilul. Ix. (Richter, in Scrofula. Also in Cu-
taneous Diseases.)

Form. 519. Pilul* Emmenagog*.
R AloSs Socot., Myrrhae, 85, 3jss. ; Galbani, Gum. Ammo-
niaci, 85, 3ij. ; Biboratis Sodae, 3jss. ; Ferri Sulphatis,
3ss. ; Ferri Sesquioxidi, 3j. ; Pulv. Rhei, 3ij. ; Olei
Rutae et Olei Sabinae, 5a, Tllxij. ; Saponis, q. s. Fiat
niassa aequalis. et divide in Pilulas cxx., quarum capiat
duas vel tres, bis terve quotidie.

Form. 520. Pilul* Eytr. Gentian* et Humuli
Comp.
R Extracti Gentians, 3ij. ; Saponis Medicin., 3jss. ; Fell.
Bovini inspiss., Ext. Aloes Purif., a5, 3j. ; Ext. Humuli,
3jss. Misce, et divide in Pilulas pond. gr. iij., quarum
capiat binas vel tres mane nucteque.

Form. 521. PiLUL* Ferri Ammonio-Chloridi.
R Ferri Ammonio-Chloridi, 3j. ; Extracti Aloes, Extracti
Gentians. 55, Jss. Contunde simul, et divide massam
in Pilulas trigiiita, quarum sumat duas ter quotidie.
(In Dyspepsia, Hysteria, Scrofula, and Mesenteric Ob-
structions.)

Form. 522. Pilul* Ferri Ammonio-Chloridi.
R Ferri Ammonio-Chloridi, 3j. ; Extr. Gentian, et Extr.
Alogs, 55, 3ij. Contunde simul, et divide massam in
Pil. xxxvj. ; e quibus bin^e, bis terve quotidie, su-
mantur.

Form. 523. Pilul* Ferri Apebientes. (1.)
R Ferri Sulphatis, Potassae Sulphatis, 55, 3J. ; Galbani,
AsafoeUda;, 55, 3jss. ; Amnion. IIydro<;lilorat., 3ij. ;
Massae Pilul. Aloes cum Myrihft, 3iij. ; Theriacaj Pu-
rif., q. s. Contunde in massam aiqualem, et divide in
Pilulas cl., quarum capiat binas bis terve quotidid.

Form. 524. Pilul* Ferri Apfrientes. (2.)
R Ferri Sulphatis, Potassae Sulphatis, 5a, 3j. ; Galbani,
AsafuetidiE, aSi. 3jss. ; Extr. Gentiana:, 3ij. ; Massae Pi-
lul. A loiSs cuin Myrrha, 3iij. ; Theriacae Purif., q. s.
Contunde in massam squalem, et divide in Pilulas cl.

Form. 525. Pilul* Guaiaci Comp. (1.)
R Gum. Guaiaci, 3ij. ; Saponis Venet., 3j. ; Calomelanos,
Antimonii Oxysulphureti, Pulv. Rail. Senega, Cani-
phorac. Si, gr. xvj. ; Aceti Scillse, q. s. Fiat massa
cqualis, ft divide in Pilulas Ixxx., quarum capiat duas
vel tres bis terve quotidii.

Form. 526. Pilul* Guaiaci Comp. (2.)
R Gum. Guaiaci, 3ij. ; Calomel., Antimonii Oxysulphureti,
55, 3SS. ; Mucilag. Acacije, q. s. M. Fiant Pilul. li.
Capiat ij.-iv., pro dfise. (In Cutaneous Alfeclions.)

Form. 527. Pilul* Guaiaci Comp. (3.)
R Guaiaci Gummi Resina; pulv., 3ij. ; Pulv. Opii Crudi,
gr. vj. ; Hydrargyri Chloridi (Calomel), gr. xij. , Anti
monii PotassiT-Tartratis, gr. iv. ; Tinct. Myrrhs, q, s.

xxn

APPENDIX OF FORMULAE.— Pilule.

nt fiat massa, in Pilulas xxxvj. dividenda. Dosis, ij.
vel iij., nocte maneque.
Form. 528. PlLULJE Guaiaci eT AntimoniI CoMp.
B Pnlv. Janobi Veri, '^j. ; Resin. Guaiaci in Pulv., Massa;
Pilul. Alo^s cum Myrrlm, 65, Jjss. ; Sirupi Simp.,q. s.
Fiat massa xqualis, et divide in Pilulas xlviij. Capiat
hinas ad quatuor pro dose. (Emmenagogue, Stomachic,
Aperient, and Antirheumatic.)

Form. 529. Pilule Hellebori et Aloes Comp.
a Extr. Bad. Hellebor. Nig., Aloes Ext. Pnrif., FeiTi Am-
monio-Chloridi, a5, 3j. ; Croci Stigmat., Jss. ; Opii
Puri, gr. V. ; Sirupi, q. s. M. Fiant Pilul. ).,quaruin
capiat binas vel tres.
Form. 530. Pilul* Hvdrargyri Anodynje.
R Pilul. Hydrar?yri, Pulveris Ipecac. Compos., Extracti
Hyoscyami, aa, gr. v. Fiat massa, in Pilulas iij. divi-
denda. Sumantur hor4 somni.

Form. 531. Pilul* Hydkargyui Bichloridi.
R Hydrargyri Bichloridi, Ammon. Hydrochlorat., aa,gr. v. ;
Aq. Destillata;, 3ss. ; Glycyrrh. Radicis Pulveris, 3iv. ;
Mellis Opt., iss. ; Pulv. Acaciie, q. s., ut fiat massa,
quam divide in Pil. xl. ; e quibus sumatur una ter die.

Form. 532. PiL. Hydrargyri Phospiiatis Composite.

R Hydrargyri Phosphatis, gr.ix. ; Antinionii Pot.-Tartratis,
gr. j. : Opii Crudi in pulv. subtiliss., gr. vj. ; Confecti-
oiiis FructOs Rosae CaniiiiE, q. s., ut fiat massa, in Pi-
lulas sex squales distribuenda, quarum unahorSL decu-
bitus sumenda.
Form. 533. Pilul* Hydrargyri et Scill*.

R Sodae Carbon, exsic, Jss. ; Saponis Duri, 3ij. ; Pilul.
Hydrarg., gr. xxiv. ; Pulv. Scillaj Rad. exsic, gr. xij. ;
Olei Juniperi, q. s. M. Fiant Pilul. xxiv., quarum
capiat unam ter die.

Form. 534. Pilul* Hydrargyri Chloridi Compo-
siT*, sEU Pilul* Plummeri.
R Hydrargyri Chloridi, Jss. ; Antimonii Oxysulphureti,
3j. ; Guaiaci Gummi Resinae contiit., 3ij. ; Saponis,
3SS. ; Olei Juniperi, Tllxxx. ; Theriacas Purificatie
(Treacle), q. s., ut fiat massa, in Pilulas sexagiuta di-
videnda.

Form. 535. Pilul* Ferri Iodidi.
R Ferri Iodidi, gr. xxx. ; Croci Stigm. pulveriz., 3j. ; Sac-
chari Albi, jiij. ; Mucilag. Tragacanth., q. s. Misce.
Contunde in massam iequalem, et divide in Pilulas xc. ;
qnarum capiat unam, binas, vel tres, bis terve quotidie.
(In Chlorosis, Amenorrhea, Scrofula, &c.)

Form. 536. Pilul* Kino Composit*.
R Kino, 3ij. ; Camph. rasEe et subactiE, 3ss. ; Oxidi Zinci,
3ss. ; Confect. Aromat., 3j. M. Divide in Pilulas
XX. Capiat binas mane nocteque. (Augustin, in Di-
abetes. Also in Afl^ections of Mucous Surfaces.)

Form. 537. Pilul* Morphi* cum Digitals.
R Morphiae Acetatis, gr. j. ; Pulv. Fol. Digitalis, gr. vj. ;
Camph. rasEE, gr. x. ; Pulv. Acaciae, gr. viij. ; Sirupi
Tolutani, q. s. Fiat massa ffiqualis. Divide in Pilulas
vj., qnarum capiat unain tertiis horis.

Form. 538. Pilul* Myrrh* et Balsami Comp.
R MyrrhiE, 3jss. ; Benzoini, 3ij. ; Balsami Copaibie. 3j. ;
Extr. Glycyrrh., 3iv. Fiant Pilul. ixiv., secnndiim ar-
tem. Capiat leger binas bis terve quotidie. (For Asth-
ma, Chronic Bronchitis, &c.)

Form. 539. Pilul* Nervin*. (Stoll.)
R Gummi Ammoniaci, Gummi Asafoetida, aa, 3jss. ; Sapo-
nis A'enet., 3.ss. ; Pulv. Castorei, Ammon. Sesquicar-
hnn., aa, gr. xxv. ; Mucilag. Acacise, q. s. M. Fiant
Pilul. Ixxx. ; e quibus sumantur bins tertiis vel quartis
horis, vel ter die.

Form. 540. Pilul* Nervin* Antimoniat*.
R Gummi Galbani, 3jss. ; Giimmi Sagapeni, Saponis Ve-
netian, aa, 3j. ; Pulv. Rhei, 335. ; Antimon. Potassio-
Tart. in Aqua Font., q.s., sol. gr. vj,-x. ; Ext. Glycyrrh.,
3j. Misce. Fiant Pilul. gr. iij. ; sumat unam ad tres
ter quotidie.

Form. 541. Pilul* Nucis Vomic*.
R Extr. Res. Nucis Vomicae, 3ss. ; G. R. AsafoBtidse, gr.
3jss. ; Sirupi, q. s. Fiat massa aequalis, et divide in
Pilulas xxx. Capiat unam bis terve in die. (Cardialgia
Spasmodica, &c.)

Form. 542. PiLUL* Nucis Vomic* Composit*.
R Morphiie Acetatis, gr. j. ; Ext. Nucis Vomicse, gr. ij. ;
Olei Olivae, gr. x. Solve ; et adde Extr. Rad. Hellebori

Nig. {Ed. Ph.), 3j. ; Pulv. Glycyrrh., gr. viij. ; Mellis,
q. s. Fiat massa aequalis, et divide in Pilulas xij. ; qua-
rum capiat unam bis terve in die. (In Chlorosis
Ainenorrhoea, &c.)

Form. 543. Pilul* cum Oleo Crotonis.
R Pilul. Aloes cum Myrrha, 3jss. ; Saponis Castil., 3j. ;
Olei Crotonis Tiglii, tllvj. ; Pulv. Glycyrrh., q. s. M.
Fiant Pilul. xxx. Capiat duas vel tres omni nocte
(In Amenorrhcea.)

Form. 544. Pilul* Plumbi Acetatis et Digitalis.
R Plumbi Acetatis, gr. iv. ; Pulverrs Digitalis, gr. vj. ,
Pnlverrs Opii, gr. iij. ; Confectioni-s Rosat Canime, q. s.
Misce, et divide in Pilulas sex aequales, quarum suma-
tur una ter in die.

Form. 545. Pilul* Plumbi Acetatis et Colchici.
R Plumbi Acetatis, gr. xij. ; Pulveris Colchici, gr. xxv. ,
Pulveris Opii, gr. iij. ; Mucilaginis Acaciae, q. s. Misce
optime, et divide in Pilulas aequales duodecira. (In act-
ive Haemorrhages, in Phthisis, <kc.)

Form. 546. Pilul* Plumbi Acetatis.
R Plumbi Acetatis, gr. viij. -xvj.: Opii Crudi pulver., gr.
iv. ; Confect. Fruct.- Rosai Caninie, q. s. In Pilulas
viij. divide. Dosis j., ij., vel iij., semel, bis, sspiusve
in die.

Form. 54". Pilul* Purgantes.
R Fel. Tauri inspissati. Aloes Extr. Purificati, aS, 3j. ;
Extr. Colocynth. Comp., Saponis Castil., ai, 3j. M.
Fiant Pilul. xxxvj.

Form. 548. Pilul* Rhei Resolventes.
ft Pulv. Rhei, Sodae Acetatis, Fellis Bovini inspiss., aa,
3ij. ; Pulv. Gum. Acaciae, q. s. Fiat massa Pilularis.
{Ph. Dan.)

Form. 549. PiLUL* Rhei Balsamic*.

R Pulv. Rhei, Pulv. Gum. Acaciie, 55, partes aequales ;
Balsam. Copaibae, q. s., ut fiat massa pilularis.

Form. 550. Pilul* Scammonijs.
R G. R. Scammon., gr. xv. ; Sacchar. Albi, gr. x. Tere
probe ; deinde adde 01. Carui, Ttliv. Fiant Pilul. vj.,
quarum sumat ij. omni hora.

Form. 551. Pilul* Scill* Composit*.

ft Rad. Scillae recent , 3ss. ; Gum. Ammoniaci, Succi Gly-
cyrrh., 55, 3j. ; Antinionii Oxysulphureti, Pulv. Nucis
MyiisticiE, iiiS, 3j. ; Sirupi Papaveris, q. s. M. Fiant
Pilulae 1., quarum capiat binas ad tres, ter quaterve
in die.
Form. 552. Pilul* Scill* cum Ipecacuanha.

ft Scillae Radicis Pulveris, Zingiberis Radicis Pulveris, aa,
3j. ; Ipecacuanhae Radicis Pulv. ,3ss. ; Saponis Duri,
3jss. ; Olei .luniperi, 111.i.xx. Contunde, ut fiat massa
in Pilulas Ix. dividenda.

Form. 553. Pilul* Sedativ*. (I.)
ft Extr. Opii, gr. j. ; Nitratis Poiassie, gr. vj. ; CamphoriE
rasae, gr. v. ; Sirupi Papaveris, q. s., ut fiant Pilul. iij.,
pro dose.

Form. 554. Pilul* Sedativ*. (2.)
ft Camph. Subacta!, 3j. ; Potassae Nitratis, 3ss. ; Extr.
Hyoscyami, Exir. Anthemidis, 5a, 3ij. ; Sirupi Papa-
veris, q.s. M. Fiant PiluJ. xxxvj., quarum capiat duas
4tis vel 6tis horis.

Form. 555. Pilul* Sedativ*. (3.)
R Camph. rasa; et subactae, gr. x. ; Extr. Hyoscyami, 3J. ,
Extr. Papaveris Albi, gr xij. M. Divide in Pilulas
xij., quarum capiat binas vel tres horft sonmi.

Form. 556. Pil. Sod* Sesquicarbonatis cum Hyos-

cyamo.
R CamphoriE, 3ss. ; (Sp. Rect., q. s., ft. tcrendo puJv.)
Sod* Sesquicarbonatis, 3jss. ; Extracti Hyoscyami,
3ij. ; Saponis Duri, 3j. ; Olei Juuiperi, Ttlxxx. ; Pul-
veris Irid. Flor., q. s., ut ft. massa, in Pil. Ix. aequales
distribuenda; qnarum sumat iij. nocte maneque, cum
Infuso Lini vel Decocto Althaeie.

Form. 55". Pilul* Stahlii.
ft Antimonii Sesquioxidi, Aloes Socot., Resin. Guaiaci, bUl,
3j. ; Croci Stig., Myrrha-, Jss. : Bals. Peruv., q. s., ut
fiat massa a;qnalis. Divide in Pilulas 1.

Form. 558. Pilul* Stomachic*. (1.)
{Grana Vita Mesue.— Frank's Grains of Health.)
R Aloes, 3iij. ; Mastiches, Petal. Rosae Rub., S5, 3j. ; Fel-
lis Tauri inspissati, 3jss. Misce bene ; divide in Pilulaa
c, quarum capiat ij. vel iij., ante prandium.

APPENDIX OF FORMULAE.— Pilule— PoTus.

XXUl

Form. 559. Pilul* Stomachics. (2.)
R Eitr. GeiitianjB, jij. ; FcUis Bovini inspiss., 3jss. ; Scam-
mon., Jj. Contiiiide in niassam sequalein, et divide in
Pilulas Ixxx. ; quarurn caiiiat binas quutiditi, vcl priaiu
maiie, vel ante prandium.

Form. 560. PiLUL* Stomachic*. (3.)
R Limat. Ferri, 3ij. ; Pulv. Canelte, 5j. ; Fellis Bov. insp.,
3s8. ; Sirup., q. s. M. Fiat massa Pilularis. (Chluru-
sis, &c.)

Form. 561. Pilul* Stomachic*. (4.)

R Limat. Ferri, Jj. ; Pulv. Rhei, Exlr. Gentianse, FcUis

Tauri insp., aa, jiij. M. Fiat massa Pilularis.

Form. 562. Pilul^lStomachic*. (5.)
R Fellis Tauri inspijsat., Extr. Aloes Purif., Extr. Gcn-
tiaux, Saponis Veiiet., aa, ?ss. M. Fiant Pilul. ixx.,
quarum capiat binas bis in die.

Form. 563. Pilul/E Stomachic* Aperientes.

R Ext. FumariiE Officinalis, Extr. Jalapa;, a5, Jj. ; Pulv.
Capsici Aniiui, gr. xvj. ; Sodie Carbon, exsic, jss.
Misce secundum artem, el divide in Pilulas xxxvj.,
quarum capiat duas vel tres hork et semisse ante pran-
dium.

Form. 564. Pilulje Stramonii.
R Extract! Stramonii, Jj. ; Saponis Duri, jij. ; Acacia Gum-
mi Pulv., 3j. ; Glycyrrh. Radicis Pulv., j)ij. ; Mucilag.
Tragacanth., q. s., ut ft. massa, in Pilulas Ix. dividenda.
Dusts, j. nucte maueque, vel ter die.

Form. 565. Pilul* Stryciini*.
R Strychniae Purif., gr. ij. ; Conserv. Rosarum, 3j. Misce
ben^, et divide in Pilulas xxiv.

Form. 566. Pilul* Styracis Composit*.
R Styracis, Jjss. ; Olibani, Benzoini, Croci, Extr. Glycyrrh.,
Mastiches, aa, jss. ; Opii Puri, 3ij. ; Myrrhic, 3ij. ;
Balsami Tolutani, 3j. Tere bene simul, ut sit massa
SBqualis. Divide in Pilulas Ixxx., quarum capiat unam,
binas, vel tres pro dose. (Each pill contains half a grain
of opium.)

Form. 56". Pilul* Sudorific*. (1.)
R Hydrargyri Chloridi (Calomel), gr. xij. ; Antimonii Po-
tassio-Tart., gr. jss. ad gr. iij. ; Opii Crudi in pulv.
subtiliss., gr. vj. Misce ; turn adde Confect. Frur.t.
RosjB Cttuinie, q. s., ut ft. massa. In Pilulas vj. aequales
divide, quarum capiat j. horii somni.

Form. 568. Pilul* Sudorific*. (Dumeril.) (2.)
R Kermis Mineral. (F. 637), Antimonii Oxysulph., ii, 3j. ;
Extr. Opii, gr. xij. ; Extr. Hyoscyami, 5ij. Divide in
Pilulas Ix. Capiat j.-ij., bis terve in die.

Form. 569. Pilul* Sulphatis Strychni*.
R Strychnia Sulphatis, gr. ij. ; Confect. Rosar., Jj. Misce
probe, et divide in Pilulas xxiv. lequales. Capiat unam
pro dose.

Form. 570. Pilul* Terebinthinat*.
R Gum. Guaiaci, 3j. ; Terel)inth. Vulg., 3jss. ; Pulv. Gly-
cyrrh., q. s., ut fiant Pilul. xxxvj., quarum capiat binas
vel tres, ter quotidi^.

Form. 571. Pilul* Terebinthin* et Camphor*
cum Opio.

Exlr. Opii, 3j. ; Pulv. Rad. Glycyrrh , 3jss. ; tere cum
Aquae pauxillo, et adde Terelimth. Venet., 2)ij. ; Cam-
phone rasae, gr. XV. ; Cruel Stigmatis, 3j. ; Mastiches,
gr. X. ; Pulv. Acacias, gr. x. ; Olei Juniperi, q. s. Tere
liene simul, et fiat massa lequulis. Dividi in Pilulas
Ix., quarum capiat duas ad tres, bis terve quotidie.

Form. 572. Piluljb Tonic* Aperientes. (1.)
R QuinEB Sulphatis, 3SS.-3J. ; Potassx Sulphatis, 3jss. ; Guio.
Galbani. 3iv. ; Extr. GeiitianEe, vel Anthemidis, Tj. ;
Massa; Pilul. Alogs cum .Mynhi, 3iij. ; Theriacae Pu-
rif., q. e. Contuude in massam xqualem, et divide in
Pilulas cxx., quarum sumantur binse vel tres, bis terve
quotidi^.

Form. 573. Pilul* Tonico-Apbrientes. (2.)
R Quinje Sulphatis, 3j. ; Ahigs Extr. Purif, Jss. ; Extr.
Gentianae, 3j. M. Fiant Pilul. xxiv., quarum sumat
unam vel binas, omni lueridie.

Fonn. 574. Pilul* Tonic* Aperientes. (3.)
R Fern Sulphatis, 3j. ; Extract! Absinthii (vel Gentianae),
Extr. Allies Purif., Sla, 3jss. ; Sirujii Croci, q. s. M.
Divide in Pilulas Ixxxv., quarum capiat binas, tres, qua-
tuorve pro dose.

Form. 575. PiLUL* Tonico-Aperientes. (4.)
R Quinas Sulphatis, Extr. Aluiis Purif., aa, 3ij. ; Extr.
Geiitiaine, 3js8. ; Sirupi Simp., q. 8. Divide in Pilulas
xlviij. ; quarum capiat duas vel tres pro dose.

Form. 576. Pn.uL* Tonico-Aperientes. (5.)
R Quins Sulphatis, 3j. ; Massse Pilul. AloSs cum Myrrhft,
3ij. ; Extr. Gentians, 3j. M. Fiant Pilul. xxx., que
rum capiat binas bis quotidie.

Form. 577. Pilul* Tonic* cum Cupro.
R Cupri Sulphatis, gr. x. ; Pulv. Rhei, -j. ; Extr. Anth*
midis, 3ij. ; Sirupi Simp., q. s. M. Fiant Pilul. xl
quarum capiat j. ad iij. (In I.eucorrhtpa, <kc., by Au
OUSTIN; and in Gleet, Chorea, &c. The Ammoni.
Sulphate of Copper is substituted for the Sulphate 1
Chorea by Niemann.)

Form. 578. Pilul* Tonic* cum Sulphate Zinci.

R Zinci Sulphatis, 3j. ; Extract! Gentianie, 3iv. ; Extr.
Anthemidis, 3ij. Coiitunde massam, et divide in Pi-
lulas xl., quarum sumantur duse bis die, cum Haustl
infra prascripto.

R Infusi Gentianaj Compositi, 3x. ; Acidi Sulphurici Aro-
mat., lllxij. ; Tinct. Zingiberis, 3j. M. Fiat Ilaustus

Form. 579. Pilul* Tonico-Emmenagog*.
R QuinsE Sulphatis, Massie Pilul. Galban. Cnnip., aS, 3ss. ;
Massae Pilul. AloCs cum Myrrha, 3j. : Olei Junip. Sa-
binae, q. s. M. Divide massam in Pilulas xxx., qua-
rum capiat binas mane nocteque.

Form. 580. PiLUL* Uv* Ursi et Rhei.
R Pulv. UvtE Ursi, Pulv. Rhei, Sa, 3ss. ; Saponis Castil.,
gr. XXV. ; Mucilag. Acaciae, q. s. M. Fiant Pilul. xx.
Capiat duas bis quotidie.

Form. 581. Pilul* Uv* Ursi et Sod*.
R Pulv. Fol. Uvae Ursi, Sodae Carbon, exsic, Saponis Dun,
aa, 3j. ; Mucilag. Araciae, q. s. M. Fiant Pilul. xl.,
quarum capiat binas bis terve quotidie.

Form. 582. PiLUL* Valerian* Composit*.
R Pulv. Valenans, gr. xxx. ; Castorei, gr. xx. ; Oxidi Zinci,
gr. XX. ; Sirupi Simp., q. s. M. Fiant Pilul. iviij.,
quarum capiat tres, ter quotidie. (Dupuytben.)

Form. 583. Pilul* Valerian* et Zinci.
R Pulv. Valerians, 3ij. ; Castorei, gr. xv. ; Oxidi Zinci,
3j. ; Olei Cajeputi, Hlv. ; Sirup. Simp., q. s. Divide
in Pilulas xviij., quarum capiat tres, quater in die.
(Nearly the same as those used by Dupuytben.)

Form. 584. Pilul* Zinci et Myrrh*.
R Zinci Sulphatis, gr. xij. ; Myrrhae in pulverem fritsE,
3jss. ; Confect. Ross, q. s., ut fiant Pilul. xxiv. ; i qui-
bus sumantui bios, bis quotidie.

Form. 585. PiL ZiNci CUM Myrrha et Ipecacuanha.

R Zinci Sulphatis, gr. xij. ; Myrrhae in pulv. trit., 3j. ;
Pulv. Ipecac, gr. xviij. ; Extr. Hyoscyami, 3ij. ; Sirupi
Papaveris, q. s. M. Fiant Pilul. xxx. ; e quibus su-
matur una, ter quaterve quotidie.

Form. 586. Pilul* Zinci Sulphatis Composit*. (I.)
R Zinci Sulphatis, gr. xij. ; Moschi, 3jss. ; Camphorie, 3ss.

M. et divide in Pilulas xxxvj., quarum sumantur du<£,

bis vel ter in die.

Form. 587. PiLuL* Zinci Sulphatis Composit*. (2.)
R Zinci Sulphatis, gr. xij. ; Pulv. Ipecac, gr. vj. ; Pulv
Myrrhae, 3ij. ; Extr. Lactucae, 3ijss. ; Sirupi Tolutani,
q. s. Coutuade in massam xqualem, et divide in Pilu-
las I'liv.

Form. 588. PoTus Antiphloo. Diubeticds.
R Derocti Asparagi Oflicin., Ibij. ; Potassae Nit., 3ij. ; Spirit.
JElY\eT. Nit., 3iij. ; Oxymel. Scillae, fss. Sit pro Potu
cooununi.

Form. 589. Potus Decocti Sabz* Comp. (Tisane ob
Feltz.)

R Antimonii Oxysulphureti, jiv. ; Aquae Com., ihxij. ;
Rad. SarzK, Jiij. ; Radicis China; Orientalis, Corticis
Lig. Buxi, Ichthyociilla-, aa, 3Jss. ; Ilydrarg. Bichlo-
ridi, gr. iij. (Enclose the Antimony in a muslin bag;
and boil the whole, excepting the Bichloride of Mer-
cury, until the water is reduced to one half; strain
the decoction, and add the Bichloride. The properties
of this decoction will not be nialerially affected by
omitting the Radix Chinae and Cort. Buxi ; or Sassafras
orGuaiacum maybe substituted, and Extractum Ta-
razaci added.)

XXIV

APPENDIX OF FORMUL.^.— PoTus— PuLvis.

Form. 590. Potus Diubeticus. (1.)
H Decocti Tritici Repen., Ibijss. ; Potassaj Acetat., fjss. ;
Spirit. .aEther. Nit., f iij. ; Acfeti Colchici, fss. ; Vini
Xerse, Jvj. ; Oxymel. Scillie, 5Jss. Sit pro Potu com-
muni.

Form. 591. PoTUs Diureticus. (2.)
B, Decocti Tritici Repentis, Oijss. ; Potassse Bitart., 3J. ;
Potassae Nit-oiij. ; Sodae Biboratis, 31J.; Sacchari, 31V.
Sit pro Potu ordinario.

Form. 592. PoTUs Febrifuqus. (1.)
R Potassas Nitratis, Jiij. ; Seri Lactis, Oiij. ; Succi Limonis,
Jijss. M. Sumat pro Potu ordinario.

Form. 593. PoTUS Febrifugus. (Stoll.) (2.)
ft Pulpa; Tamarindorum, 5ss. vel Jvj. ; Potassae Nitratis,
3i]. vel jiij. ; Seri Lactis, Oijss. M. Oram bihorio su-
matur vasculum cotiaeanum.

Form. 594. Potus Mann* et Tamarindorum.
R Mannae, Conserv. Tamarindi Indici, a5, f j«s. ; Seri Lac-
tis, Ibjss. Digere et cola. Capiat cyathum subinde.

Form. 595. PoTUS Refriqerans.
R Acidi Hydrochlorici, jj. ; Spirit. jEther. Nit., Jiiijss. ;
Decocti Hordei Comp., Jx^'v. M. Capiat cyathum
pro re nata. (la Febrile Affections.)

Form. 596. PuLvis Acidi Benzoici et Camphors.
R Acidi Penzoici, gr. vj. ; Camphorae, gr. ij. ; Sacchari
Albi, 3j. M. Fiat Pulvis. Dispens. tales doses tres.
Capiat Eeger altera quaque hora unum.

Form. 597. PuLvis Ai.min^ et QuiNiE.
R AlumiiiK Sulphatis, gr. viij.-xij. ; Quina; Sulphatis, gr.
i.-iij. ; Gum. Arab., Sacchar. Albi, &a, gr. xij. Fiat
Pulvis. Dispens. tales dundecim. Capiat leger tertia
quaque hora pulverem unum. (In Adynamic Fevers,
Hiematemesis, Passive Haemorrhages, <S5C.)

Form. 598. Pulvis Cupri Ammonio-Sulphatis cum

ZiNCO.

R Cupri Animon.-Sulphat., Oxydi Zinci, a5, gr. ss.-j. ; Sac-
chari Albi, gr. X. M. Fiat Pulvis. (In Epilepsy and
Chorea.)

Form. 599. Pui.vis Antihydropicus.
R Potassae Bitart., fj. ; Potassae Nitratis, Biboratis Sodae,
aa, 31J. ; Pulv. Fol. Digitalis, 3j. Tere bene simul, et
divide in Chartulas xij., quaruni capiat unam bis terve
quotidie, in quovis decocto vel infuso.

Form. 600. Pulvis Antimonii et Camphor^;.
R Antim. Oxysulphureti, Radicis Ipecac, 5a, gr. j. ; Campli.
rasae, gr. j.-iij. ; Sacchari Albi, 3j. M. Fiat Pulvis.
Dispells, tales doses sex ; sumat aeger alter^ quaque
hora Pulverem unum. (In Chronic Inflammations of
the Respiratory Organs.)

Form. 601. Pulvis Antimonialis Compositus.
R Pulveris Antimonii Comp., 3v. ; Antimonii Oxysulphu-
reti, 3j. M. Dosis gr. v., pre atate adulti.

Farm. 602. Pulvis Antiphlogisticus.
R Pi'tassae Nitratis, Ji'j- ; Potassae Tartratis, Jivss. ; Acidi
Boracici, 5J- Tere in pulv. subtiliss. (In doses of 3ss.
in Cutaneous Affections, &c.)

Form. 603. Pulvis Antispasmodicus. (Stahlii.)
R Kermis Mineral., gr. j. ; Potassae Nitratis, Potassae Sul-
phatis, aa, gr. x. Misce bene.

Form. 604. Pulvis Aperiens.
R Pulveris Jalapae, f lij. ; Hydrargyri Chloridi, fj. ; Pulve-
ris Zuigibeiis, 31]. Misce. Dosis, d gr. iv. ad gr. xx.

Form. 605. Pulvis Asari Compositus.
R Asari Folior. exsiccat., f iij. ; Origani Folior. exsiccat.,
Lavaiidul. Floruin exsiccat., aa, 5J. Simul terantur, et
fiat Pulvis. (In Chronic Ophthafiiiia and Toothache, as
a sternutatory, &c. : to produce a secretion from the
Schnciderian membrane.)

Form. 606. Pulvis BELLADONNa;.
R Pulv. Rad. Belladonna;, gr. iv. ; Pulv. Rad. Glyoyrrh. et
Sacchari Albi, 5a, gr. xxviij. Tere heni simul. Dosis,
gr. iv.-xx., bis in die.

Form. 607. Pulvis Belladonna: Compositus.
R Pnlv. Rad. Belladonnae, gr. vj. ; Pulv. Ipecac, gr. vj. :
Pulv. Rad. Glycyrrh., Pulv. Sacchari Allii, aa, 3ss. ;
Sulphuris Priecipit., 3ij. ; Olei Anisi,01ei Succini, 85,
llliij. Misce. lu dosis gr. v.-xx.

Form. 608. Pulvis Belladonn* Compositus.
(Hecker.)
ft Pulv. Fol. Belladonnae, gr. j.-iij. ; Moschi, Camphorae, a3,
gr. V. ; Sacchari Albi, 3ss. Tere bene, et divide in
Chartulas viij. (Antispasmodic. For Pertussis, Asth-
ma, &c.)

Form. 609. Pulvis Bismuthi.

R Bismuthi Trisnit., gr. ij. ; Magnes. Calcinat, Sacchan
Albi, aa, gr. x. M. Fiat Pulvis; terti^ vel quartet

quaque horii sunieudus. (Odier.)

Form. 610. Pulvis Bismuthi Compositus.
ft Bismuthi Trisnitrat., Moschi, aa, gr. ij. ; Extr. Hyoscy-
aiiii, gr. iij. ; Magnes. Carbon., gr. v. M. Fiat Pulvis,
tertia quique hora sumendus. (MaBCUS.)

Form. 611. Pulvis Boracis et Sabin*:.
ft Pulveris Foliorum Sabina;, Pulv. Zingiberis, aa.gr.vij. ;
Sodffi Biboratis, 3j. Fiat Pulvis, bis die sumendus.
(In AmenorrhcEa with a languid pulse.)

Form. 612. Pulvis Calomelanos cum Digitale.
ft Hydrargyri Chloridi, Sacchari Albi, aa, fj. ; Pulveris
Digitalis, 5ss. Misce. Dosis, a gr. j. ad gr. v.

Form. 613. Pulvis Calumbj: Compositus.
ft Pulveris Calumbae, f j. ; Pulv. Rhei, fss. -^ Sodae Carbo
natis exsic, 3iijss. Misce. Dosis, a gr. vj. ad 3ss., bis
de die.

Form. 614. Pulvis Camphorje.
ft Camphorae, 3ss ; Sp. Rectif., q. s. Ft. terendo pulv. ;
dein adde, Sacchari Purificati, 3j. ; Pulv. Acaciae, 3js9.
M. Fiat Pulvis. In chart, x., lequaliter distnbu-
endus.

Form. 615. Pulvis Camphors: et Zinci.
ft Camph. rasae, 3j. ; Zinci Oxidi, gr. xv. M. In Chartu-
las iv. dislribue ; quarum sumat unam hora somni.
(In Epilepsy supervening about puberty, and connected
with venereal desires and indulgences.)

Form. 616. Pulvis Carminativus. (1.)
ft Magnesiae, gr. viij. ; Seminum Anisi contns., Seminum
Fu^uiculi cont., aa, gr. ij. ; Croci, gr. j. ; Sacchari Albi,
gr. vij. Contunde bene simul, et sit Pulvis. Capiat
dimidium statim, et alterum post horam. (For the Tor-
mina of Infants, &c.)

Form. 617. Pulvis Carminativus. (2.)
ft Magnes., Sacch. Albi, 53, 3j. ; Pulv. Corticis Canell;e,
Semin. Fceniculi cont., a5, gr. xx. ; Olei Anisi, lllviij.
Tere benfi simul, et divide in Chartulas xij., quarum
capiat unam bis terve quotidie, vel urgentibus tormi-
iiibus.

Form. 618. Pulvis Carminativus. (3.)
ft Sem. Anisi, Sem. Carui, Sem. Coriand., Sem. Fecniculi,
aa, 5j. ; Cort. Auran., Rad. Zingib., 5a, 3vj ; (,'retae
Prepar., f jss. ; Magnes.. fss. : Macis, 3jss. ; Sacchari
Albi, 5ij. ; tere bene simul. Dosis, 3j.-3ij.

Form. 619. Pulvis Catharticus.
R Hydrargyri Chloridi, Pulveris Cambogiae, Pulv. Jalapae,
Pulv. Rhei, Pulv. Ciimamomi, aa, 3ij. Misce. Dosis,
i gr. V. ad 3j.

Form. 620. Pulvis Cinchonje Compositus.
R Pulv. CinchoniE,5Jss. ; Pulv. Moschi, gr. xv. ; Camphorse,
3j. ; Ammon. Sesqnicarbon., gr. xxv. ; Olei Succini
et Olei Menthae, aa, lllvj. Misce probe, et divide in
Pulv. viij.

Form. 621. Pulvis Cinchona cum Soda.
R Pulveris Cinchonae, Soda Carbouatis, ii, partes aequales.
Dosis, d gr. v. ad 3ss., bis terve in die.

Form. 622. Pulvis Corticis CuspARiiE Comp.
ft Pulv. Cort. Cuspariae, gr. x. ; Pulv. Cinnam. Comp., gr.
vj. ; Olei Pimentae, tllj. M. Fiat Pulvis, ter in die
capiendus.

Form. 623. Pulvis Cret.e et Rhei Compositus.
R Cretae Praepar., Jss. ; Sapouis Amygdal., Pulv. Rhei, 5S,
3j. ; Hydrarg. cum Cretil, 3j. ; Olei Fieniculi, TItviij. ;
Sacchari Albi,, 3ij. ; tere bene simul. Capiat gr. vj.
ad 3ss. pro dose bis vel ter die. (Pro Infantum Diar-
rhffia.)

Form. 624. Pulvis Cretaceus.
R CrotiB Preparata", Acacia; Giimmi Ver. pulv., Sa, fiv. ;
Sacchari Purificati contrili, fiij. Misce. Ft. Pulvis.

Form. 625. Pulvis Cyanidi Zinci.
R Zinci Cyanidi, gr. vj. ; Magnes. Calcinata;, gr. iv. ; Pul-

APPENDIX OF FORMULAE.— PuLvis.

XXV

TOTis Cinnamomi, gr. iv. M. Fiat Pulvis, qaartd qui-
quc iKirft siimeaiJus. (In Gastrodynia, Dysiiienorrhoea,
Ijyspepsia.)

Form. €26. PuLvi-s Deobstruens.
R Cnm. Cuaiaci, r,iy. ; Flor. Snlphur., ?jss. ; Calomelanos,
3j. ; Radiois Iridis Flor., Semin. FiEiiicvili, flS, 3J8S. ;
Opii Extr., gr. ij. ; Sacxiliar- Albi, fss. Tere beue si-
mul, et divide in I'ulv. vj.

Form. €27. Pulvis Diureticus. (1.)
R Potassffi Nit., Potassao Bitart.,4a, 3iv. ; Pulv. Scills, gr.
viij. ; Pulv. Zing., gr. xvj. Misce beuti, et divide in
Chartulas viij.

Form. 628, PuLVis DtuRETicus. (2.)
ft Potasss Bitart., 3jss. ; Pulv. Scillje cxsic, gr. ij. ; Pulv.
Digitalis, gr. j. ; Pulv. Ziiigil)eris, gr. v. Fiat Pulvis,
terquaterve quotidie sumendusex theriacA.

Form. 629. Pulvis Eccoproticus.
H Potassai Bitart., 5J,; Magnes. Carbon., Flor. Sulphur.,
aa, Jss. ; Potassie Nit., 3ij. Misce, et divide in Chart,
vj. (In Hemorrhoids, <fcc.)

Form. 630l Pulvis Ecpheaticus- (1.)
R Potassie Bitart., fss. ; Soda; Biboratis, Magnrs. Carbon.,
ai, 3ij. ; Pulv. Flor. Aiithemidis, Pulv. Seniin. Fceiii-
culi, ia, 3ij. ; Sacchari Albi, fss. ; Olei Juniperi et Ol.
Anisi, ii, Tllitv. Terc bene simuU Cajuat 3j.-5ij.,bis
terve quotidie.

Form. 631. Pulvis Ecphractici's. (Sellii.) (2.)
ft Magues. Carbon., Potassie Bjlart., Sulphuris Subliniati,
Pulv. Rhei, Pulv. Flor. Anthemid., Pulv. Seminum
FoEiiiculi (vel potius Sacchari Albi, 3.SS. ; Olei Funi-
culi UuL, TtlLtiv.), aa, fss.; Olei Junijieri, Tllicviij.
Tere bene simul. Capiat 3j.-3ij., bis terve quotidie
et vehiculo quovis idoneo. (In Obstructions, Jaundice,
Piles, &c.)

Form. 632. Pulvis Excitans.
R Biboratis Sodae, gr. xv.-3j.; Pulv. Sabius, gr. vj. ; Pulv.
Castorei, Pulv. Rad. Zingih., aS, gr. x. M. Fiat Pul-
vis. Suniat ifigra de die Pulveres binos in vino vel cum
melle. (Stimulans et eninienagogus in Menstruorum
defectu ex LeucuphlegmasiSl. HaETMann.)

Form. 633. Pulvis Infantilis.
R Rhei Radicis Pulveris, 3ij. ; M.ignes. Carbonatis, 31. ;
Zingiberis Rad. Pulv., 3ss, M. Fiat Pulvis. Capiat
gr. vij. ad 3SS. pro dose.

Form. 634. Pulvis Ipecachanh* cum Calomelane.
R Hydrargyri Chloridi, 3ij. ; Pulv. Ipecac, 3j. ; Pulv. Cin-
namuini, 3JSS. ; Sacchari Albi, 31JSS. M. Dosis, a gr.
ij. ad gr. i.

Form. 635. Pulvis Jalaps; Compositus.
ft Jalapae Rndicis Pulveris, fj.; Potassa; fiitartralis, fij. ;
Capsici Baocarum Pulv., gr. xij. Omnia, seorsim trita,
perniisce. Dosis, £k 3ss. ad 3j. mane.

Form. 636. Pulvis Jalap£ et Calomelanos.
R Pulv. Rad. Jalapao, gr. xv.-xx. ; Hydrarg. Chloridi, gr.
ij. ; tere probe cum Sacchar. Alb., 3ss. ; et adde Pulv.
Acaciae, 3j.; 01. Carui, Tllij. M. Fiat Pulvis, stalim
sumeudus.

Form. 637. Pulvis Kermis Mineralis.
(Hydro- Stilphuret of AatimOHy. Berzelius.)
R Aqua; Pluvial., part. 280; Carbon. SodiE, part. 128; Scs-
quisulphuieti Antimonii pulver., part. 6. Dissolve the
Soda in the water while boiling ; and tioil the Sul|ihu-
rel in the solution for half an hour, stirring it frequent-
ly. Filter the boiling liquor in a vessel containing
warm water which had been previously boiled. De-
cant the water after it is cooled. Wash the precipi-
tate which is formed, tirst with cold water, afterward
with warm water, until it passes otT quite insipid.
Lastly, press it, and dry it in the shade.* (Stimulant,
Emetic, Diaphoretic, Alterative, Becchic, Ex|>ectorant.
Dose j.-iv. gr.)

Form. 638. Pulvis Kermis Minebalis et CamphoBjE.
R Kermis Mineral., gr. ij. ; Camph. subact. in Pulv., gr. iij. ;
PotassiB Nit., gr. T.-iij. M.

Form. 639. Pulvis Kermis Mikeralis Cauphoratus.

R Kenais Mineral., gr. iij. ; Camph. pulverizntie, gr. viij. ;
Pulassa; Nitratis, gr. xxiv. ; Sacchari Albi, 3ss. Tere
bene, et divide in Pulv. iv. Capiat unani, quatcr in die.

* I have given the directions for Ihi.** preparation, and a few others,
iM F.o^Ufb, to preveot auy juistalLe occurring la respect of tiieuL

Form. 640. PuLVis Lenitivus HypocHONDRlACUS.

(Ki.EIN.)

R Flavedinis Cort. Aurant., Pulv. Radicis Rhei, Potasss
Tartratis, ii, 38s. ; Olei Cajeputi, Ttliij- M. Ft. Pul-
vis pro una dose.

Form. 641. Pulvis Lientericus.
R Pulveris Tragacauth. Comp., Pulv. Rhei, Sa, 3iij. ; Pulv.
Ipecac. Comp., 3j. ; Hydrargyri cum Creta, 3j. Misoe.
Dosis, A gr. V. ad ..ss., 3tiis, 4tis, vel 6tis horis. Inter-
dum adde Extractuin Catechu, &,c.

Form. 642. Pulvis Nitro-Opiatus Ipecacuanha, vel
Pulvis Doveri.

R Ipecac Radicis cnntrit., 3j. ; Opii Crudi contriti, gr. xlv. ,
Potass!£ Nitratis, 3viij. et gr. xv. Tere simul, et fiat
Pulvis. (A scruple of this powder contains one graia
and a half of opium, two grains of ipecacuanha, and
sixteen grains and a half of nitrate of potass.)

Form. 643. Pulvis Puroans.
ft Hydrarg. Chloridi, Cambog. G. R. pulveriz., Pulv. Zin-
giberis, aa, 3ss. ; Saochari Purif., 3j. Tere bene si-
mul; et adde Olei Fu;niculi Dulcis, Ttlxx. Dosis, gr.
v. ad XV.

Form. 644. PuLVfs Refrioerans. (1.)
R Acidi Boracici, fss. ; Potassie Nitratis, fj. ; Potasss Bi-
tart., f ij, Misce bene. Capiat 3j.-3j. pro dose.

Fx>rm. 645. PuLvis Refrioerans. (2.)
R Potassae Bitartratis pulverizati uncias duas ; Nitratis
drachmas tres. Misoe, et divide in paites xij. a;quales.

Form. 646. Puuvis Resolvens, vel Deobstruens.
R PotassiE Bitartratis pulverizati, f ivss. ; Sodie Biboratis,
5 jss. ; Antimonii Potassio-Tart., gr. iij. Misce prob&
et divide in partes aequales viginti.

Form. 647. Pulvis Ruei Compositus.
R Pulveris Rhei, 3iijss. ; Hydrargyri cum Creta, 3j. ; Po-
tassie Carbon., 3jss. , Pulv. Cinnanjoiui, 3ss. Misce.
Dosis, 2I gr. v. ad 3j., bis vel ter die.

Form. 648. Pulvis Rhei kt Maonesi£.
R Pulv. Rhei, 3j.-3ss. ; Magn. Carb., gr. ivj.-3ss. ; Semin.
F(rniculi, Sacchari Albi, aa, gr. x. ; Olei Cassis Ciu-
nam., Illj. M. Fiat Pulvis.

Form. 649. Pulvis Rhei et Sulph. Potass*
ft Pulv. Rhei, gr. vj.-x. ; Potassffi Sulphatis, gr. x.-3j. ,
Pulv. Sem. Anisi, gr. vj. ; Dlei Fceniculi, tiy. M. Fiat
Pulvis, bis terve quotidie sumendus.

Form. 650. Pulvis Scahmoni£ cum Calomel. (1.)
ft Scamnion. Gum. Resinse pulv., 3ij. ; Hydrarg. Chloridi,
(Calomel), Sacchari Purificati, aa, 3j. M. Fiat Pulvis.
Dosis, gr. X. ad gr. xx. mane.

Form. 651. Pulvis Scam.moni.e cum Calomel. (2.)
R Scammon. Gunimi Resinie pulv., Hydrarg. Chloridi, Po-
tassie Bitart., aa, 3ij. Misce bene siniul, et sit Pulvis.

Form. 652. PuLvis Scammoni£ et JalaPjE.
ft G. R. Scammoniae, gr. xij. ; Pulv. Rad. Jalapie, gr. xviij. ;
Potassie Bitart., gr. xxv. Tere prob^ in pulverem te-
niiissimum ; dein adde Pulv. Zingiberis, gr. viij. ; di-
vide in partes tres lequales, quaruni suniat j., secundi
vel tertid q. q. hori, donee pleni dcjecerit alvos.

Form. 653. Pulvis Sedativos.
R Hydrarg. cum Cret4, 3J. ; Pulv. Ipecac. Comp., 3ij. ;
Magnes. Carbon., 3ss. Tere bend simul. Dosis, gr.
iv.-xij., pro Infantibus.

Form. 654. Pulvis SeneCjG et Camphor.f..

ft Pulv. Rad. Senpgie, Sacch. Alb., 33, gr. xij. ; Camph.
rasiE, gr. ij. ; Olei Anisi, TIlj. M. Fiat Pulvis Dis-
pensentur tales doses tres. Capiat «;ger, interjectis
duabus horis, pulverem uouni. (In Chronic Affections
of the Chest.)

Form. 655. Pulvis SoDiE Compositus.

R Sodffi Carbon, exsiccat., 3vj. ; Hydrargyri Chloridi, 3j. ;
Pulv. CretiE Comp., fj. Misce. Dosis, a gr. v. ad 2)j.

Form. 656. Pulvis Sod^e cum Hydrarotro.
R Sodie Carbon, exsic, 3iv. ; Hydrarg. cum Creli. 3i].
Misce ben^. Dosis, gr. vj. ad gr. xij., pro Infantibus
bis quotidi^.

Form. 657. Pulvis Specificus Stomachicus. (Po-
terii.)
R Ferri Seiquioxidi, Antimonii Crudi, aS, partes oequales
vel unam ; Putassa: Nitr., part. vj. Detoua sea defla-
gra, et lava.

;£xvi

APPENDIX OF FORMULA.— PuLvis—SiRUPua

Form. 658. PuLVfs Sulphatis Potass.b et Ferri.
R Ferri Sulphatis, 3vj. ; Potassae Sulphatis, ^xij. Tere
ben6 siniul, et addeAcidi Sulphurici, lllxxxvj. M.
Dusis 3J.-3JSS., bis, ter, quaterve in die.

Form. 659. Pulvis Sulphatis Quin* Antimoniatus.

R Quiiiae Sulphatis, gr. xij. ; Antimonii Potassio-Tartrat.,
gr. ij. Misce tietie, et divide in partes vj. asquales. Ca-
piat unam 2dis vel 3tiis horas inter paroxysmos.

Form. 660. PuLvis Sulphatis Quins; et Morphije.
R Quins Sulphatis, gr. iv.-xij. ; Morphia Sulphatis, gr.
].-ij. Misce, et divide in dos. iv. vel vj.

Form. 661. Pulvis Sulphureti Aureati Antimonii,
te/ Deuto-Suphuret. Antim. (Berzelius.)

R Liquoris restantis post prscipitat. Mineralis Kermes
diet, quantum veils; infunde Acid. Acetici quantum
sufficiat, vel donee nil amplius prueeipitationis appareat.
Lava bend materiam praecip. et exsicca. (N.B. The
Oxysulphuret of Antimony of the Lond. Ph. is an ad-
mixture of Kermes Mm. and the Golden Sulph.)

Form. 662. PuLvis Tonicus.
R Ferri Sulphatis exsiccata;, 3iij. ; Potassie Sulphatis, 5ij. ;
Pulveris Cascarillae, 5iijss. Misce. Dosis, a gr. iij. ad
gr. XV., bis terve in die.

Form. 663. Pulveres Tonici.
R Pulv. Cinchnnse, Extr. Glycyrrh., aa, ^iij. ; Pulv. Rad.
Valerian., 3ij. ; Sacchan Aibi, 3ss. Tere ben^ simul,
et divide in Chartnlas ix. Capiat unam ter quotidi6.
(Heller and Niemann.)

Form. 664. Pulveres Tonico-Aperientes.
R Pulv. Cinchonse, fj. ; Pulv. Rhei, 3ijss. ; Ammon. Hy-
drochloratis, 3jss. Misce bene, et divide in Chartulas
lij. (Bang et Jadelot.)

Form. 665. PuLvis VALERiAKa: et Zinci.
R Valeriana; Pulv., 5J. ; Oxid. Zinci, 3j. ; Moschi, Sacchari
Purif., aa, gr. xT; Olei Cajeputi, Illxij. Tere simul, et
divide in Chartulas vj., quarum capiat unam ter die.

Form. 666. PuLvis Zinci Oxydi Compositus.
R Oxydi Zinci, gr. xij.; Magnes. Calcinatae, 3ss. ; Pulv.
Calumbie, 3j. Tere bene simul, et divide in Chartu-
las xij., quarum capiat unam ter quaterve in die. (De
HaEN.)

Form. 667. Pulv. Zinci Sulphatis Comp.
R Myrrhae G. R., 3j. ; Pulv. Ipecac, gr. vj. ; Zinci Sulpha-
tis, gr. vj. ; Pulv. Glycyrrh., Sacchar. Albi, aa, 3jss.
Tere optimfi simul ut fiat Pulvis. Divide in Chartulas
ix., quarum capiat unam ter quaterve in die ex the-
riaca.

Form. 668. Sapo Olei Crotonis Tiglii.
R Olei Crotonis Tiglii, partes ij. ; Lixivii Saponarii, part. j.
Contere, et fiat Sapo. Dosis, gr. ij. vel lij.

Form. 669. Sapo Terebinthin.*:.
R Potassae Hydratis, fj. ; Liquefac lento igne, et adjice
Olei Terebinthina, fiij. Misce bene donee refrixerat.
(Used both externally and internally.)

Form. 670. Sapo Terebinthinata.
R Saponis Castil., fj.; Olei Terebinth , 51JSS. ; adde Solu-
lioiiis Potas.ste Carbon., 3ij. ; Camph. rasffi, 3ij. Misce
bene. (Used externally and internally.)

Form. 671. Solutio Iodinii. (Lugol.)

No. 1. No. 2. No. 3.
R Iodinii . . . . gr. ij. gr. iij. gr. iy.

Potassii lodidi . . . gr. iv. gr. vj. gr. viij.
Aquie Destil. . . . tbj. Ibj. Ibj.

Solve. (Chiefly for external use ; for injections in
Scrofulous Fistulae, &c.)

Form. 672. Solutio Iodinii Caustica. (Lugol.)
R Iodinii, jj. ; Potassii lodidi, fj. ; Aquae Destillata:, fij.
Solve.

Form. 673. Solutio Iodinii Rubefaciens. (Lugol.)
R Iodinii, 3iv. ; Potassii lodidi, 5j. ; Aquae Bestillats, fvj.
Solve.

Form. 674. Solutio Morphi.e HyDRocuLORATis.
R Morphia; Hydrochlorat., gr. x. ; Aquae Destillat. Calid.,
UllOOO. Solve. (Dose twenty-five minims — equal to
i gr. of the Hydrochlorale.)

Form. 675. Solutio Morphije Sulphatis.
R Sulphatis Morphiae Ver., gr. iv. ; Aq. Destil., 5j. Solve.
(Of the same strength as Laudanum.)

Form. 676. Spiritu.s .^thebis HyDROCHLORici.
(Olim, Spiritus Febrifugi Cluttoni.)
R Acidi Sulphurici, Ibj., Jt'j- (per pond.) ; Acidi Hydro-
chlorici, ibj. (per pond.) ; Spiritfls Rectificati cong., j.
Distilletur liquor, secundum arteni.

Form. 677. Spiritus Ammonia Anisatus.
R Olei Anisi, 3iij. ; Spirit Ammon., fvj. Solve.

Form. 678. Spiritus Castorei Ammoniatus.
R Castorei contr., fiij. ; Croci Stigm., Jj. ; Herbae Arte

misiiE, fvj. ; PotassK Carbon., 3ij.; Spirit. Tenuioris,

f XXX. Macera per dies vj., et cola. Dein adde Spirit.

Ammon., Liquoris Ammon., aa, fvj. M. Dosis, 3j.-3ij.

Form. 679. Spiritus Castorei Comp.
R Castorei contr., fiij. ; Croci Stigm., fj. ; Herbae Arte-
misiae, fvj. ; Spirit. Tenuioris, Ibijss. Macera per dies
sex, et cola. Deinde adde Olei Anisi, Olei Juniperi,
Olei Ruts, aa, 3j. M. Dosis, 3SS.-3JSS., 3tiis vel 4tis
horis.

Form. 680. Spiritus Terebinthinatus.

R Olei Terebinth., fjss. ; Spirit. Vini Rect., fvj. Distilla

leni cum calore. Dosis, Tllvj.-xx. (In Jaundice.)

Form. 681. Spiritus Terebinthinatus Comp.
R Saponis Albi, fij. ; Opii, fss. ; Spirit. Vini Junip. (valgb
HoUandii) f xijss. ; Spirit. Terebinth. Rect., f iv. ; Cam-
phorae, 3vj. Macera bene, et cola. (Externally as a
Liniment ; and internally in Cidics and Nephritic Com-
plaints, in doses of from 10 to 20 drops, and in Dropsies.)

Form. 682. Suppositorium Opiatum.
R Opii Puri, gr. ij. ; Saponis Duri Hisp., gr. iv. Simul
contunde, et fiat massa pro Suppositorio.

Form. 683. Suppositorium Plumbi Compositum.
R Emplastrum Plumbi, part. viij. ; Abietis Resinae cont^
part. ij. ; Opii Puri pulveriz., part, ss.-j. Solve Em-
plastrum et Resinam ,' deinde adde Opium, et forma in
Supposit.

Form. 684. Sirupus Belladonn.«.
R Fol. BelladonnsE, 3ij. ; Rad. Bellad., 3j. ; Sacchar. Albi,
Ibj. Aquae, q. s., ut sit Decocti, ibj.

Form. 685. SiRUPUs Morphi.*: Acetatis.
R Morphia Acetatis, gr. iv. ; Sirupi Clarificati, f xvj. Misce
ut fiat Sirupus. (In doses of from two tea-spoonfuls to
a table-spoonful every three hours, or only at bedtime.)

Form. 686. Sirupus Mokphi* Sulphatis.
R Morphiae Sulphatis, gr. iv. ; Sirupi Clarificati, fxvj.
Misce. (In the same doses as the Acetate. May be
given alternately with the Acetate.)

Form. 687. Sirupus Papaveris.
R Extracti Papaveris Veri (in vacuo praep.), f j. Solve in
Aq. DestillatK Ferventis, Oj. ; cola, et adde Sacchari
Purificali, Ibijss.

Form. 688. Sirupus Potassii Sulphureti.
R Potassii Sulphureti, 3j. ; Aq. Hyssopi vel Foeniculi, fij.
Solve, et adde Sacchar. Albi, f iv. ; et macera in balnau
arenario.

Form. 689. Sirupus Quinj:.
R Sirupi Simpliois, fviij.; Quinae Sulphatis, gr. xixij
Capiat Cochlear, ij. minima, bis terve de die.

Form. 690. Sirupus Rhei Compositus.
R Rad. Rhei concis. et contus., f iij. ; Fol. Senna;, fij. ; Ca
nellae Corticis cont., fss. ; Seinin. Funiculi cont., fj. ;
PotassiE Carbon., 3!J. ; Rad. Zing, concis., 3j. ; Aquae
Ferventis, tbij. Macera per horas viginti quatuor loco
in culido, et cola. Liq. colato adde Mannae, f iij. ; Sacch
Purif, tbiijss. Fiat Sirupus.

Form. 691. Sirupus Senn.£ et Manna.
R Fol. Sennae, fiv. ; Semin. Fitniculi cont., fjss. ; Sem.
Anisi cont., jiij.: Radicis Zingil)eris, 3jss. ; Aq. Fer-
ventis, Oiij. Digere per horas quatuor; exprinie et
coin. Dein colaturffi adde ManniE Optimae, fvj. ; Sac-
chari Albi, fxxij. ; et fiat Sirupus.

Form. 692. Sirupus Sulphureti Sodii.
R Soda Purs (cum Alcoh. prsep.), 3j. ; Aq. Destillat., Jt.j

APPENDIX OF FORMULiE.— SiRUPcs— TiNCTURA.

XXVll

Liquefac. leni igne, et adde Sulphuris Puri quantum
sulvi putcst.
R Liquoris, 5J. ; Sirupi Communis, f xxxj. Misce bene in
vase lienti oblurato. (Doses of 5J.-51J. lor infants, Jj.-Jiij.
for adults.)

Form. 693. Tinctuka Acetatis Ferri Comp.
R Acetatis Plumbi, 3SS. ; Ferri Sulph., Jiij. ; Aceti, A!co-
bolis, ia, fij. ; A(i. Rosas, Jvj. Solve Acel. Plumbi in
Aceto cum lento igne ; dein adde Sulph. Ferri in Pulv.,
cui post solutiouem, infunde Alcohol, cum Aq. Rosae
permislum.

Form. 691. Tisctura Acetatis Morphle Composita.
B Morphia Acetatis, gr. xvj. ; solve in Aq. Destil., Jiij. ;

Acidi Acetici, lllv. ; Tmct. Lavandul. Co., 5vj. ; Spirit.

MjristiCifi, vel Tinct. Ciunamom. (Joinp., 3vij. M. Do-

sis, 11U.-3J.

Form. 695. Tinctura ^therea Valerian*.
R Radicis Valerian, pulver., 3J. ; jEtheris Sulphurici non-
rcctiticat., 3vj. ; Alcohol. Rectif., 5J. Macera per tri-
duum ct cola.

Form. 696. Tinct. Aloetica Alkalina. (Saxon Ph.)
R Croci Stigmat. in pulv., part. j. ; AloSs Socot. in pulv.,
part. jss. ; Myrrhic pulv., part. ij. ; Carb. Potassa;, part.
iv. Misce, et pone in locum humidurn ut deliquescat ;
dein infunde Aq. Fervcntis, part. xij. Macera per bo-
ras duodecim, et adde Alcoholis Concent., part, duode-
cim. Digere leni cum calore per dies tres, et cula. In
dos. 3SS.-3JSS.

Form. 697. Tinctura Alkalina Potass*.
R Potassx Hydratis, fss. ; Alcoholis Concent., f iv. Ma-
cera per dies septem in balueo arenario.

Form. 698. Tinctura Alkalina Stibiat*.
R Antimonii Crudi, jj. ; Potassie Carbon., jij. Melt in a
crucible, and reduce them to yellowish scorise ; then
powder them immediately in a hot iron mortar, and
pour upon them rectified Alcohol, fvj. Macerate for
three days, and filter.

Form. 699. Tinctura Amara.
R Alogs Socot., 5'v. vel. v. ; Gum. Myrrhae, Mastirhes,
Benzoes, Kad. Calunibs concis., aa, §ij. ; Rad. Ceii-
tianiE, 5jss. ; Croci Stigm., Jj. ; Spirit. Virii Gallici
(Brandy), Itix. ; Spirit. Vini Hollandii (Hollands), Ibilj.
Macera per mensem, et cola. (The celebrated " Urogue
Amere" of the Jesuits, and an excellent tonic and ape-
rient.)

Form. 700. Tinctura Ammoniaci Alkalina.
R Gummi Ammoniaci, fiij. ; Liq. Polassie Carbon., fijss. ;
Myrrhie, ;j. ; Alcoholis, Oj. Macera per dies septera,
et cola. Uosis, 3SS.-3JSS,

Form. 701. Tinctura Balsamica. (1.)

R Olei Terebinth., fj. ; Tinct. Myrrhae, fij. ; Tinct. Ben-

zoiui Comp., f iv. Macera in loco calido. (Internally,
and to Indolent Sores, &c.)

Form. 702. Tinctura Balsamica. (2.)
R Balsaini Tolulani, ;ss. ; Balsami Peruviani, Styracis Bal-
saiui, Acid. Benzoic, Myrrha;, 33, 3iij ; Croci Stigmat.,
3ij. ; Spirit. Vim Rect., gxx. Macera per dies tres, et
cola. ( Wirtemburg Ph. nearly.)

Form. 703. Tinctura Balsami Tolutani.
R Balsami Tolutani, ?) ; Semin. Anisi cont., ?j. ; Acidi
Beiizoici, JSS. ; Spirit. Reutificat., Oj. Digere, donee
solvatur Baisamuin ; dein cola.

Form. 704. Tinctura BelladonnjE.

R Belladonnae Foliorum exsiccatorum, fij. ; SpiritOs Te-

nuioris, Oj. Macera per dies quatuordecim, et cola.

Form. 705. Tinctura Benzoica Anodyna.
R Camph. rasJB, 3jss. ; Ipecac, Balsami Tolutani, 5a, 3ss. ;
Acidi Benzoici, 3ij. ; Opii Puri, Croci Stig., aa, 31JSS. ;
Olei Anisi, 3j ; Spirit. Viai Ten., Ibij. Macera bene,
et cola. Dosis, lllvj.-xxi. (The Tinct. Opii Benzoica
Compos, of the AusT. Phar., and Tinct. Anodyno-Hu-
dorific. of various foreign Pharmacoj)u;ia3.)

Form. 706. Tinctura Bruoi*.

R Brucis Purs, gr. xij. ; Alcoholis (s. g. 637), 3). Solve.

(3j. contains gr. jss. of Brucine. Dose 5ss.-3ij.)

Form. 707. Tinctura Calami.

R Calami Radicis contasi, fiv. ; SpiritOs Tenuioris, Oij.

Macera per dies quatuordecim, et per chartam cola.

Form. 708. Tinctura Camphorje Thebaic*.
ft Opii Pulveriz., 3iij. ; Camphorae, 3vj. ; C'oriicia Canella
contus., Croci Stigmat., &&, 3ij.; Caryophyllorum, Pulv.
Capsici, aa, 3jss. ; Potass^e Carbon., 31J. ; Olci Anisi,
3jss. ; Spirit. Vini Tcnuior. (vel Sp. Vmi Gallicie, vel
Sp. Vini Hollandii), Oij. Macera leni cum calore per
dies viij. ad xij. ; dein exprinie et cola.

Form. 709. Tinctura Caryophvllorum.
ft Caryophyllorum contus., fiij. ; Spirit. Vini Tenuior.,
Oij. Macera bene, ct cola.

Form. 710. Tinctura Cascarillje Alkalina.
ft Corticis Cascarillie cont., fiv. ; Potassje Carbon., ?ss. ;
Spirit. Tenuior., Ibij. Macera bene, el cola. Dosis,
3J--3"'j-

Form. 711. Tinctura Castorei Alkalina.
ft Castorei contus., fiij. ; Potassae Carbon., 3iij. ; Croci
Stigm., 31J. ; Spirit. Rorisniarini, Ibij. Macera per tri-
duum, et cola. M. Dosis, 3ss.-3ij.

Form. 712. Tinctura Centaurii Cacuminum.
ft Centaurii Cacuniin. (flowering tops of Centaury), fiij. ;
Spiritfls Tenuioris, Oij. Digere per dies quatuorde-
cim, et cola.

Form. 713. Tinctura Cinchoni* Sulphatis.
ft Cinchonias Sulphatis, gr. xxxvj. ; Alcoholis Rect., fiij.
Solve. Dosis, 3j.-3iij.

Form. 714. Tinctura Conii.
ft Conii Foliorum exsiccatorum, fij. ; Cardamomi Seminum
contusoruni, 3iij. ; Spiritfls Tenuioris, Oj. Digere per
dies septem, et per chartam cola.

Form. 715. Tinctura Digitalis .^therea.
ft Fol. Digitalis exsic. et pulv., part. j. ; ^ther. Sulphur.,
part. iv. Macera per triduum, et cola. (Dosis,
Tllxx.-xxx. ter die. Several Continental Pharmaco-
poeias.)

Form. 716. Tinctura Diosm* Ckenat*.
ft Fol. Diosinae Crenatae, fij. ; Spirit. Tenuioris, Oj. Ma-
cera per dies septem, et cola. (Dose 3j.-3iij.)

Form. 717. Tinctura Diubetica.
ft Olei Juniperi, 3ss. ; Spirit. ^Etheris Nitrici, Tinct. Digi-
talis jEtherea;, aa, 3iij. M. (Dosis, 3SS.-3J., ter qua-
terve in die. Hufeland.)

Form. 718. Tinctura Ferri .Stherjea.
ft Acidi Hydrochlorici, fij. ; Acidi Nitrici Dilut., f jss. ;
Ferri Liinaluras, q. s. Dissolve the iron in the acids ;
evaporate to dryness ; afterward deliquesce the residue
by exposure to the air, and mix the deliquesced li juor
with double its weight of Sulphuric iEther, ajjitating
the mixture frequently until it assumes a golden yel-
low colour; then decant, and add double the quantity
of rectified Alcohol. This Tincture may be used pre-
viously to Ihe addition of the Alcohol, or subsequently.
In the state of jEther the dose is from 16 to 2U drops ;
in that of ^Ethereal Tincture, from 20 to 30 drops. It
is useful in Diseases of Debihty, and in Spasmodic Af-
fections.

Form. 719. Tinctura Fructus Vanill*.
ft FructOs Vanillae concis. et contus., part. j. ; Alcoholis,
part. vj. Macera leni cum calore per dies octo, et cola.
(Nervine, Analeptic, Excitant, &c. Pfaff.)

Form. 720. Tinctura Galbani Composita.
ft Galbani Gummi Resinae, fjss. ; Pinientae Baccaruiu con-
tus., fj. ; Cardamomi Semin. contus., fss. ; Spirit.
Rectif., Oj. Aq Destil., Oss. Macera per dies qua-
tuordecim, et cola.

Form. 721. Tinctura Gall*.
ft Gallarum contus., fij. ; Spirit. Tenuioris, Oij. Macera
per dies octo, et per chartam cola.

Form. 722. Tinctura Iodinii Fortior.
ft Iodinii, 3ij. ; Spirit. Rectificat., fj. Solve, tereudo in
vase vitreo. (3j. contains five grains of Iodine.) Dose
m.vj.-xiiv.

Form. 723. Tinctura Iodinii Mitior.
ft Iodinii, gr. xxiv. ; Spirit. Rectif., f j. Solve, terendo in
vase vitreo. M. (3j. contains gr. iij. of Iodine. j

Form. 724. Tinctura Lobeli* Inflate.
ft Herb. Lobeliac Inflatae exsic, fij. ; Spirit. Vini Ten., Oj
Digore per dies decern, et c(da. (Emetic in doses of
3j. to 3ij. ; Antispasmodic in doses of Ulxx. to jss- ; aod
Diuretic in smaller quantities.)

XXVlll

APPENDIX OF FORMULAE.— Tinctura—Unguentum.

Form. 725. TiscTURA-MYliRHa: Alkalina.

ft Myrrha;, ?j. ; Potassffi Carb., ;vj. ; Aq. Ferventis, f iij.

Tere ; Uem maceVaiu <)alnei) aren. ad inellis crassituci.,

et adde Spirit.' Teiiuioris.f"- Macera bene, et cola.

Capiat 3j.-3ij.'ex lut'uso Aiitheniichs. (In Scrufula, &c.)

Form. 726. Tinctura Nervosa. (Riemerii.)
■ft Spirit. Coma Ce-rvi Rect., part, iv, ; adde gradatim Al-
cohol. Rect., part. xvj. ; Camphonfi, part. ij. ; Olei Ju-
mp., partem j. Solve.

Form. 727. TiNCTUHA Nucis Vomicje.
ft Extract! Nucis Vomica exsic, gr. iv. ; Alcoholis (36°),
5j. Solve. (3j. Tiuct. ad gr. ss. Extract!.)

Form. 728. Tinctura Opii Camphorata.
(Sive Elixir Paregoricum Pharm. Pristin.)
R Camphone, 3ij. ; Opii Crud. in pulv., Acidi Benzoici,
55, 5j. ; Olei Anisi, 3ss. ; Pota.ss. Carbon., 3j. Omnia
in mortario simul optima terentur ; paulatim affunde
Spiritus Tenuioris, Oij. ; stent in digestione per dies
decern ; turn adde Railicis Glycyrrh. mcisae, Jiv. ; di-
gere iterum per dies septem, et cola.

Form. 729. Tinctura Opii Composita.
(Vel Laudanum Liquidum Verum Sydenhamii.)
ft Opii Puri contrit., fij. ; Croci,5j. ; Cort. Canella;, Cary-
ophylloruin, aa, 5jss. ; Spirit. Vini Rect., 51V. ; Vini
Ilispan., Ibj. Macera cum leni calore per dies xvj. ;
dein exprime et cola. (Illiv. equal to 1 grain of pure
opium.)

Form. 730. Tinctura Phellandbii. (Marcus.)
ft Semin. Phellandrii Aq., fss. ; Alcoholis, fvj. Macera
per horas xxiv., et adde Vini Burgundia;, fvj. Macera
per dies tres, et cola. Capiat lllx.-li. (In Chronic
Bronchial and Pulmonary Affections.)

Form. 731. Tinctura Quinje Sulphatis.

ft QuiniE Sulphatis, gr. viij.; Spiritus Vini, fj. M. Fiat
Tinctura.
Form. 732. Tinctura Quince Sulphatis Acid.

ft QuinsB Sulphatis, gr. xlviij. ; Tinct. Aurantii Comp.,
5VSS. ; Acidi Sulphunci Dilut.,3ij. M. Fiat Tinctura.
(Dosis, 3ss. ad 31J.)
Form. 733. Tinctura RllATANia:. (Sprague.)

ft Krameriie Radicis contus., jiij. ; SpiritOs Tenuioris, Oij.
Digere per dies octo, et per chartain cola.
(This Tincture is strongly impregnated with the medi-
cinal virtues of the root. It is a very grateful tonic,
when given according to the following formula:

ft Infusi Rosse, 3x. ; Acid. Sulph. Aromat., Tllxv- ; Tinct.
Rhataniue, Sirupi RhoBados, aa, 3j. M. Fiat Haustus,
ter in die hauriendus.)

Form. 734. Tinctura RhatanIjE Aromatica.
ft KrameriiE Radicis contus., 5iij. ; Canella; Corticis contus.,

?ij. ; Spiritfts Tenuioris, Oij. Digere per dies decem,

et per chartam cola.
The following is an agreeable method of exhibiting this

tincture :
ft Infusi Aurantii Compositi,fvj. ; Tinct. Rhatanife Aromat.,

Siriipi Zingiberis, 5a, fj. Misce. Fiat Mistura; cujus

sumat coch. ampla iij. ter in die, urgente Languore vel

Flatu. (Spbague )

Form. 735. Tinctura Rhei Anisata.
ft Radicis Rhei concis., Radicis Glycyrrh. concis., aa. f ij. ;

Seminum Anisi contus., Sacchaii Purif , aa, fj. ; Spiri-

tOs Tenuioris octanos, ij. Macera per dies quatuorde-

cim, et cola.

Form. 736. Tinctura Rhodii.
ft Rhodii Ligni ras., ?iv. ; Spiritus Rectificati, Oj. Macera

per dies quatuordecim, et per chartam cola.

Form. 737. Tinctura Sabin/E Alkalina.
ft Olei Essent. Sabina', ^ij. ; Tinct. Alkalina;, Jvij. et 3ij.
(F. 696). Solve. Dosis, TIlxx.-xxx.

Form. 738. Tinctura Senn.e Amara.
ft Fol. Senns. part. vj. ; Radicis Gcntiante concis., part. iv. ;
Corticis Aurantii exsic, part. ij. ; Cardamimi. Semin.
C(mtus., part. j. ; Spirit. Vim Ten., partes xlv. Macera
per dies quatuordecim, et cola.

Form. 739. Tinctura Stramonii.
ft Datnrie Stramonii Seminum contus., f ij. ; Spiritfls Te-
nuioris, Oj. Macera per dies quatuordecim, et cola.

Form. 740. Tinctura Strtchni*.
ft Strychniae Purae, gr. ij. ; Alcoholis (sp. gr. 838), Jj.
Solve, Dusis, niviij. ad xxx.

Form. 741. Tinctura Tabaci.

H Fol. Nicot. Tabaci, ^ij- ; Alcohol. Rect., Oj. Macera
per dies septem ; exprime et cola.

Form. 742. Tinctura Tabaci Composita.
ft Tabaci Foliorum concis., Jss. ; Camph. rasse, 3iij. ; Spirit.
Rectif., Aq. Destil., aa, Jiv. Macera per dies octo, et
cola.

Form. 743. Trochiscus Catechu Extbacti.
ft- Catechu Extracti Pulv., f iij. ; Cinnamomi Corticis in
pulv., 3jss. ; Olei Cinnamomi, Ti\y. ; Sacchari Purificati,
5xiv. ; Mucil. Tragacanth.. q. s. Fiat massa in Tro-
chiscos formanda. (Spraque.)

Form. 744, Trochiscus Ipecacuanha;.
ft Ipecac. Radicis Pulv., 3iv. ; Sacchari Purificati, Ibij. ;
Mucil. Tragacanth., q. s. Misce secundum artem ut
fiat Troch. 480. (Each lozenge contains half a grain of
Ipecacuanha. In recent Coughs and in DiarrhcEa.)

Form. 745. Trochiscus Lactucje.
R Extract. Lactucs Concentrat. (Probart's), Extracti Gly-
cyrrh., Pulv. AcaciiE Ver., aa, 3iv. Usee optime terantur
simul, et cum Aqui fiat massa, in Trochiscus formanda.

Form. 746. Trochisci Nitro-Camphobati.
ft Extr. Opii, gr. vij. ; Camph. rasae, gr. xxvj. ; Potassse
Nitratis, 3ijss. ; Sacchar. Pnrif, 3iij. ; Mucilag., q. s.
Misce bene, et divide in Tabulas 1., quarum capiat
vj.-x. per diem. (Chaussieb.)

Form. 747. Trochiscus Potassje Nitbatis,
R Potassse Nitratis Pulv., Jiv. ; Sacchari Purificati, ftj,

HaBC optime terantur simul, et cuin Mucil. Tragacanth,

fiat massa in Trochiscos formanda.

Form. 748. Trochiscus Zinci Sulphatis.
R Zinci Sulphatis Purif., 3iv. ; Sacchari Purificati, Ibfj.

Haec oplime terantur simul, et cum Mucil. Tragacanth.

fiat massa in Trochiscos formanda. (This mass should

be equally divided, so that each lozenge may contain

gr. J of the Zinc.)

Form. 749. Unguentum Antimonii Potassio-Tartra-
Tis, vel Febrifuoum. (1.)

ft Antimonii Pot.-Tart., gr. xxv. Solve in Aq. Destil., q,
s. ; dein adde Antimonii Pot.-Tart. in pulv. subtiliss.
redacti, 3jss. ; Adipis Pra'parat., 3X. Misce bene, et
fiat Unguentum. (Produces Phlogosis, and its anti-
mony is partially absorbed.)

Form. 750. Unguentum Antimonii Potassio-Tab-
tbatis. (2.)
ft Antimonii Pot.-Tart. in pulv.,3j. ; Adipis PriEparat., f j, ;
Camph. rasa; et subact., 3j. ; Olei Cajeputi, ttlxv. ;
Moschi, gr. iij. Misce ben6.

Form. 751. Unguentum Antimonii Potassio-Tar-
tratis. (3.)
ft Antimonii Pot.-Tart., 3jss ; Adipis Prjeparati, fj. ; Bal-
sami Peruviani, Tllxv. M.

Form. 752. Unguentum Abgenti Nitbatis.
ft Argenti Nitratis Pulv., gr. xl. ; Adipis Prsepar., fj. ; Liq,
Plumbi Di-acet., 3ij. M. Fiat Unguentum.

Form. 753. Unguentum Balsami Pebuviani
ft Balsami Peruviani, 3j. ; Unguenti Elemi Comp., Jvij.
Unguento baliieo in aquoso liquefacto, adjice Balsamum
Peruvianura, et fiat Unguentum.

Form. 754. Unguentum Belladonnje, (1.)
R Belladonnae Fol. recent., Adipis Prieparatae, iia, fiv. Ths
leaves are to be bruised in a marble mortar ; after which
the lard is to be added, and the two incorporated by
beating. They are then to be gently melted over the
fire ; and after being strained through a cloth, and the
Belladomia well pressed, the ointment is to be stirred
till quite cold. (Sprague.)

Form. 755. Unguentum Belladonna. (Chaussier.) (2.)
ft Ext. BelladonniE, 3ij. ; Aq. Destil., fjss. Tere cum Un-
guenti Simp., vel cum Axungia, fijss. M.

Form. 756. Unguentum Calomelanos et Camphor*,
ft Calomelanos, Camphorce, 53, 3j. ; Olei Carj-oph., Ttliv, ;

Unguent. Simp., 3ij. M.
Form. 737. Unguentum Calomelanos cum Camphora.
ft Calomelanos, jij. ; Camphors, Jj. ; Unguenti Simp, (vel

Ung. Sambuci Flor.), 3vj. Al. Fiat Unguentum.

Form. 758. Unguentum Camfhorje Compositum.
ft Saponis Albi rasi, f jss. ; Camph, rasie, 3iij. ; Olei Tere*

ADDENDA TO APPENDIX.— Balsamom^Bqu/s,

XXIX

binthin., f ss. Misce paulatim, et adde Liq. Ammoniie,
3J. M.

Form. 759. Unoubntum Comitiss^.
K Olei Pimcnta!, Olei Olivse, Sa, jijss. ; Ceras Flavtc, 5j.
Solve, et aJde Pulv. Pimentic, ;iij. : Pulv. Gnllaruin,
Pulv. Nucis Cupressi, Pulv. Seni. Pluntagiiiis, Pulv.
Fell. ToxicoJend. , 95, ?jss. ; Sulphalis Aluiiiinis, Jj. ;
Camphori£ rasa;, 31J. Misre beiiu, et sit Uuguentum.

Form. 760. Unquentum Cupri Acetatis.
R Cupri Acetatis, Hydrargyri Chlorid., 88, _'j. ; Cerati Re-
sins, 3J. ; Terebinth. Vulgari.s, fss. Liquefac. Resinse
Ceratuin in balnco aquoso, ot Terebinthinam adjine ;
tunc Cupri Acetatera et Hydrargyri Chloridum (prius
commistos) insperge, et omnia niisce.

Form. 761. Unouentum Deobstruens. (1.)
R Amnion. Hydrochlorat. pulveriz., 3j. ; Ungucnti Hydrarg.
Fort., 5J. ; Extr. CicutiE, 5jss. Misce bene, et fiat
Uuguentum. (Db. Hunepeld. Tumours, Indura-
tions, <kc.)

Form. 762. Unquentum Deobstruens. (2.)
R Unguenti Hydrarg. Fort., part. xciv. ; Ammnn. Hydro-
chlorat. pulveriz., part. vj. Misce bend. (M. Dupuy-
tben.)

Form. 763. Unouentum Gallx Opiatum.
R Gallarum in pulv. subtil., 3iij. ; Opii Crudi Pulver., 3j.
Unguenti Plumbi Acetatis, fiij. M. Fiat Uuguentum.

Form. 764. Unouentum Gallx Opio-Camphoratum.

R Pulv. Nucis Gallarum, 3j. ; Camph. rasa et subactae in
pauxillo Alcoholis, 3j. ; Pulv. Opii Puri, Potassae Ni-
tratis pulveriz., aa, 3ss. ; Adipis Praeparata;, 3iij. , Olei
Pinientie, Tllxii.-xvj. Misce bene, et sit Unguentum
ter quaterve in die applicandum.

Form. 765. Unguentum Hypochloridis Sulphuris.
R Sulphuris Hypochloridis, 3j. ; Unguenti Simplicis, 5J.
Misce l)en6. (For Lepra, Psoriasis, and other Chronic
Eruptions.)

Form. 766. Unouentum Potassii Iodidi.
R Potassii Iodidi, 5ss. ; Adipis Praeparatte, Jjss.

Form. 767. Unguentum Iodinii.
R Iodinii, gr. xij. ; Potassii Iodidi, 3iv. ; Adipis Suillae re-
cent. pra;par., Jij. M.

Form. 768. Unguentum Iodinii Opiatum.
R Iodinii, gr. xv. ; Potassii Iodidi, 3j. ; Adipis recent, pra^p.,
jij. Misce beni, et adde Extr. Opii, gr. xxx. ; Tinct.
Opii, 3j. Sit Unguentum

Form. 769. Unouentum Iodidi Hydraroyri.

No. 1. No. 2. No. 3.
R Iodidi Hydrarg. . . 3ij. 3iij. 3iv.

Adipis Suillie recent. . f ij. Jij- f'j-

Misce.

Form. 770. Unguentum Iodidi Plumbi.
R Iodidi Plumbi, 3)j.-3iij. ; Adipis Suil. reccntis prsepar.,
fij. Misce.

Form. 771. Unguentum Nervinum.
R Unguenti Althaea; (vel Ung. Sambuci), Jiv. ; Liq. Ammon.,
?j. ; Caniphorae, Petrolei, Spirit. Terebinth., 85, Jss. ;
Olei Rorismarini, 3ij- ; Olei Bergawii, 3j. M. (Hufe-

LAND.)

Form. 772. Unguentum Populeum.
R Gemmae vel Oculor. Populi Balsamiferaj vel Nigrs con-

tus., Itjss. ; Butrei recentis,- lf>j. LTqiiefac simul lento
igue, vel in balneo arenario, et Mprinie.

Form. 773. Unguentum Populeum Compositum.
R Gemmic Populi Dijs, vel NJg. recentis, •Ibjss. Conrtunde
cum Adipis Praparat., Ihirj., et> adde Fiil. reccntis Hy-
oscyami Nigri,F<>l. rocentis Belladonnn', 55, 51V. Con-
tunde simul, et niucera Icni cum cnlore donee dispareat
huniiditas ; dein expriine. (All the German Pharma-
copoeia-s.)

Form. 774. Unguentum ad Porrioinem. (I.)
R Sulphuris Sublimati, Unguenti Picis Liquid*, 5a, 5Js«. ;
Sapoiiis Mollis, Aininou. Hydrochloratis,a5, jss. Misce.
Fiat Unguentum.

Form. 775. Unguentum ad Porrioinem. (2.)
R Hydrargyri Chloridi, 3ij. ; Alumiiiis Exsiccati, Plumhi
Carbonatis, a8, yss. ; Terebinth. Venet., 3vj. ; Cerati
Celacei, Jjss. Misce. Fiat Unguentum.

Form. 776. Unouentum Sulphureti Iodinii.
R Sulphureti Iodinii, gr. xv.-xxv. ; Axungia;, 5j. M.

Form. 777. Unguentum Zinci Iosatis.
R Zinci lodatis, 3j. ; Adipis Praeparatae, fj. M.

Form. 778. Vinum Aloes Alkalinum.
R Aloes Socot., Cioci Stigin., Myrrhie, aS, ?j. ; Potassae
Carbon., ?ij. ; Vini Alb. Hispan., tbij. Macera per dies
xij., et cola. In dos. 3ij.-5J. (In Pyrosis, Dyspepsia,
&c.)

Form. 779. Vinum Aloes et Sod£ Compositum.
R Soda; Carbonatis, Jiij- ; Ammon. Sesquicarbonatis, 3ivss. ;
Myrrhae, 3vj. ; Alofs Extracti, Jvj. ; Vini Albi {Sherry,
Anglice), jxxiv. Macera per dies septem, et cola.
(The dose is from one fluid drachm to half a fluid
ounce.)

Form. 760. Vinum Anthelminticum.
R Extr. Aloes, Asafcetidx, Radicis Gentianae, Camphorae,
Corticis Aurantii sic, Caslorei, 55, 3j. ; Croci Stig.,
3j. ; Spirit. Vini Ten., tbiij. ; Vim Oporto, Ibiij. Ma-
cera leni calore, et post horas xij. cola. Capiat 3ij.-3ij.
in Decocto Anthemid., &c.

Form. 781. Vinum Diureticum Anti-arthriticwm.
R PotasstE Carbon., 3ijss. ; Pulv. Rhei, Juniperi Baccar.
cont., 55, 3jss. ; Rad. Zedoarii concis. et contus., 3ij. ;
Canellae in pulv., 3iij. ; Scillae Rad. exsic, 3j. ; Vini
Xera;, Jxxxij. Macera bene, et cola. Capiat Jj.-f ij.,
bis terve quotidie.

Form. 782. Vinum Ferri Citratum. {Phar. Wirlem.)
R Ferri Limaturae, ^iv. ; Aurantiorum Amar., No. iv. Ex-
corticatis Aurantiis, cortices et succulenta caro fruc-
tuum cum Limaturis Ferri in pastaiii redigantur mor-
tario in^lapideo. Dies post tres infunde Vini Madei-
rensis, fxij. ; Tinct. Aurantii, ?ij. Macera per diem
integrum, et cola. Dosis, 3ss.-3jss.

Form. 783. Vini Ferri Comp.
R Ferri Sesquioxidi, fj., vel Ferri Fragmentor., ?iij. ; Ra-
dicis Calami Arom., jij. Infunde Vini Albi Hispanici,
Ibij., et stent in digeslione per dies 6-8. Exinde su-
niantur quotidii uncia una vel duae, et suppleatur
vinum.

Form. 784. Vinum QuiN*.
R Vini Madeirensis, Jviij. ; Quina; Sulphatis, gr. xvj. M.

ADDENDA TO APPENDIX OF .FORMULAE.

Form. 785. Balsamum Odontalgicum.
R Opii Puri, Camph. rasie, 55, 3j. ; solve in Spirit. Rect.
Terebinth., 3jss. ; Olei Caryoph. et 01. Cajeputi, aS,
3SS. ; Balsam. Peruvian., 3ij. Misce bene.

Form. 786. Bolus Camphorje Compositus.
R Camphors, gr. v.-xv. ; Hydrarg. Chlorid., gr. v.-xx. ;
Opii Puri, gr. j.-iij. ; Conserv. Rosarum, q. s., ut fiat
Boius.

Form. 787. Bolus Camphor* et Hyoscyami.
R Camph. subacta, gr. v.-xij. ; Extract. Hyoscyami, gr.

v.-x. ; Potassa; Nitratis, gr. v.-viij. ; Conserv. Rosar.,
q. s. M. Fiat Bolus, hora somni snniendus. (lo
Puerperal Mania, and in Mania after Evacuations, to
be accompanied with cold sponging the head.)

Form. 788. Bolus Catechu.
R Catechu Extr., gr. viij.-xij. ; Confect. Aromat., gr. viij. ,
Sirup., q. s. M. Fiat Bolus.

Form. 789. Bolus Moschi et Camphors.
R Moschi, gr. v.-x. ; Camph. rasae, gr. iij.-viij. ; Spirit.
Rcct., Ttlj. ; Confect. Ros. Gall., q. a. Cainphoram cum
Spiritu lere, et deinde, secundum artem, liat Bolus.

ADDENDA TO APPENDIX.— Electuarium—Haustus.

Form. 790. Electuarium Deobstruens.
R Pirtassae Bitart., fj. ; Biboratis Sods, 3iij. ; Sulphur.
PrsECipit., Jvj. ; Coiifectioiiis Senna;, 5Jss. ; Sirup. Zin-
giberis, ^vj. ; Sirup. Papaveris, Jiij. M. Fiat Elec-
tuarium, cujus capiat cochlearia duo minima omui nocte.

Form. 791. Electuarium Ferri Sesquioxidi.
R Ferri SesquioxiJi, Sirupi Zingiberis, 3a, Jss. ; Confectio-
nis Aurantiorum, Jij. M. Fiat Electuarium, de quo
capiatur moles nucis moschata; bis vel ter quotidid.

Form. 792. Emplastrum Antimonii Potassio-tar-

TRATIS.

R Emplast. Piris Comp. quantum velis ; super Alutam ex-
tende, et Antimon. Pot. -Tart, pulvere leviter insperge.
Fiat Emplastrum.

Form. 793. Emplastrum Picis et Petrolei.
R Picis Liquidie, f ij. ; Galbani, 5j. ; Sulphuris, Succini, aa,
jij. ; Semin. cumini cont., Pulv. Flor. Anthemidis, aa,
3jss. ; Petrolei, fss. Liquefac Galbanum cum Aceti,
q. s., idque misce cum Pice liquida ; dein adde alia, et
misce bene.

Form. 794. Enema Commune.
R Sodii Chloridi, 3vj.-5j. ; Decocti Avenae, f x. ; Olei Lifli,
fjss.-Jijss. M. Fiat Enema.

Form. 795. Enema Ipecacuanha:.
R Rad. Ipecac, contrit., Jj. ; Aq. Ferventis, Jr. Macera
per horam et fiat Enema.

Ewm. 796. FoTUS Conii.
R Conii FoHor. ezsic, f j. Coque ex Aquae, Oijss. aU Oij.,
et cola.

Form. 797. Gargarisma Capsici.

R Capsici Baccarum contus., gr. xv. ; Aq. Ferventis, fix.
Infunde per horas tres, et cola.

R Liquoris Colati, f vijss. ; Acidi Hydrochlorici, Ttlxxv. ad
Tllxxxv. ; Tiiict. Myrrhae, siijss. ; Mellis Rosee, fss. M.
Fiat Gargarisma. (The Biboras Soda;, Extractum Cat-
echu, or any other astringent, may be substituted, ac-
cording to circumstances, in the place of the Hydro-
chloric Acid.)

Form. 798. Gargarisma cum Soda Chlorinata.

R Liquoris Sodse Chlorinate, 5xij. ; Aq. Destillat., fvj. ;

Mellis, fss. M. Fiat Gargarisma, saepe utendura.

Form. 799. Gargarisma Stimulans.
R Infusi Petal. Rnsae Gallicse, ^^jss. ; Acidi Hydrochlor.
Diluti, 3ij. ; Tinct. Capsici, 3jss. ; Mellis, 3iij. Fiat
Gargarisma saepe utendum.

Form. 800. Gargarisma Zinci Sulphatis.

R Zinci Sulphatis, 3j. ; Aq. Rosae, jvij. ; Oxymellis Simpl.,

f. 5j. M. Fiat Gargarisma, frequenter utendum.

Form. 801. GuTTiE ^there«.
R Camph. rasae, 3j. ; Spiritus ^ther. Nit., fss. ; Tinct.
Valerians, fij. ; Aq. Fontanae, fjss. M. Capiat 3sb.
ad 3ij. pro dosi.

Form. 802. Guttje jEtherej; Absinthii.
R Olei Absinthii, 3ss. ; Spirit. jEtheris Sulphurici Comp.,
et Spirit. Vini Rect., aa, 3ij. M. Sumat aeger gut.
xx.-xxx. omni hor4, aut omni bi aut trihorio.

Form. 603. Gutt* Antispasmodicje.
R Tinct. Ammon. Comp., 3vj. ; jEthcr. Sulphur., fj. : Olei
Anthemidis, Jj. ; Tinct. Opii Comp , 3ij. ; Extr. Papa-
veris Albi, 3j. M. Capiat lllxx.-xlv. in cyatho Infas.
Anthemidis, vel Iiifus. Flor. Sambuci, vel Decoct. Hor-
dei Comp., &c. (Grimaud.)

Form. 804. Gutt.e Odontalgic^e.
R Opii Puri et Camphorae, 55, gr. i. Solve in pauxillo Al-

coholis, et adde Olei Caryophyl., 3j. ; Olei Cajeputi, 3j.

Misce bene. — Vel,
R Camph. rasae, 3ss. ; Tinct. Opii, 3j. ; Creasoti, 3j. Misce

bene.

Form. 805. Haustus CHLO«iNiE.
R Solutionis Chlorinae, 3sa. ; Aq. Destillat , 3xij. ; Sirup.
Papaveris Albi, 3ss. M. Fiat Ilaustus, 5tis vel 6tis
horif sumendus.

Form. 806. Haustus Arsenicalis.
ft Confectionis Aromaticie, 3j. ; Aq. Menth. Sativs, fj. ,
Tinct. Opii, Liquoris Potass^ Arsenitis, 65, Ttlvj. M
Fiat Haustus, ter quotidie sumeudus.

Form. 807. Haustus Balsami Peruviani.
ft Balsami Peruviani, Hl,v. ad 3j. ; Mucilag. Acaciae, 3js3
Tere simul ; et adde. Mist. Camphors, 3vj. ; SpiritOs
Anisi, 3iss. ; Aq. Anethi (vel Aq. Cinnam.), jss. Fiat
Haustus, ter quaterve de die capiendus.

Form 808. Haustus Belladonna et Cinchonje.
ft Decocti Cinchonae, 3xiv. ; Extract! Cinchonae, gr. x. ;
Tinct. BelladonniE, Tllxx. (See F. 704) ; Tinct. Aurau-
liorum, 3jss. M. Ft. Haustus, ter in die capiendus.

Form. 809. Haustus Diaphoreticus.

ft Vini Ipecac, Vini Antimonii Pot. -Tart., 5a, Illx. ; Liq.

Ammon. Acet., 3ijss. ; Mist. Camphorae, f j. ; Tinct. Hy-

oscyami, Ttlxxv. ; Spirit. jEther. Nit., 3ss. ; Sirupi Au

rantii, 3j. M. Fiat Haustus, quartis horis capiendus.

Form. 810. Haustus Emmenagogus.
ft Decocti Aloes Comp., 5J. ; Biboratis Sodse, 3ss.-3j. ;
Tinct. Aloes Comp., 3).; Tinct. Castoiei, 3j. ; Tinct.
Croci, 3ss. ; Aquae Cinnam., 3ij. Fiat Haustus, omni
nocte sumendus.

Form. 611. Haustus Htosctami et Anisi.
ft' Extracti Hyoscyami, gr. iij.-v. ; Tinct. Scillae, ITlx.-xij. ;
Spirit. Anisi, 3jss. ; Aq. Anisi, jjss. ; Acidi Nitrici,
Ttlviij. Fiat Haustus, horis tertiis vel quartis durante
paroxysmo DyspnoeiB, <fec., capiendus.

Form. 812. Haustus Nervinus.
ft Spirit. Ammon. FcEtid., Tinct. Colchici Comp., Spirit.
.(Ether. Nit., 5a, 3ss. ; Liquor Ammon. Acet., 3ij. ;
Mist. CamphorK, 5J. ; Sirupi Croci, 3j. M. Fiat Haus-
tus, bis terve in die sumeudus.

Form. 813. Haustus Pectorams.
ft Balsami Peruviani (vel Bals. Tolutani), 3ss.-3ss. ; Olei
Anisi, 1Uv.-x. ; Extr. Conii, gr. iij.-vj. ; Mucilag. Gum-
mi Acaciae, 3ij. ; Aq. Pimentae et Aq. Fceniculi, aa,
jss. M.

Form. 814. Haustus Quassije et Ferri.
ft Tinct. Ferri Sesquichlor., Ttlvj.-xij. ; Infusi Quassiae, Aq.
Cinnam., aa, 3vj. ; Tinct. Calumbffi, 3j. M. Fiat Haus-
tus, mane et meridie sumendus.

Form. 815. Haustus Salinus.
ft Potassae Carbonatis, 3j. : Succi Limonum recentis, fss. ;
Mist. Camphorse, fj. ; Potassas Nitratis, gr. x. ; Sirupi
RhtEados, 3j. M. Fiat Haustus, qu£irl& qu4que hor^
sumendus.

Form. 816. Haustus Salinus Aromaticus.
ft Potassae Carbonatis, 3]. ; Succi Limonum recentis, fss.
vel q. s. ; Aquae, f j. ; Spirit. Myristicae, Sirupi Aurautii,
aa, 3j. M.

Form. 817. Haustus Salinus Demulcens.
ft Mist. Ainygdal. Dulc, Mist. Camph., aa, fss. ; Vini Ipe-
cac, Hlx. ; Potassae Bicarbonatis, gr. xv. ; Sirupi Scilla,
3j. M. Sumatur cum Succi Limouis coch. uno am-
plo, in effervescentiiE impetu ipso.

Form. 818. Haustus Salinus Sedativus.
ft Potassae Nitratis, gr. vj.-xv. ; Sodae Carbon., gr. x.-3jss. ;
Tinct. Hyoscyami, 3ss. (vel Tinct. Camphorae Comp.
pristin., 3j.) ; Mist. Camphorae, Aq. Menth. Virid., hi,
3vj. ; Sirup. Croci, 3ss. M. Fiat Haustus, tertiis vel
quartis horis sumendus.

Form. 819. Haustus Sedativus.
ft Ammon. Sesquicarbonatis, gr. xv. ; Aq. Destillat., fj. ;
Spirit. Myristicae, 3j. ; Sirupi Aurantii, fss. ; Extr.
Conii, gr. iij.-vj. Fiat Haustus, ter quaterve quotidie
sumendus, cum Succi Limonis recentis cochleari uno
magno, iu effervescentias impetu.

Form. 820. Haustus Sedativus cum Magnesia.
ft Magnes. Carb., 3ss. : Aq. Menth. Virid., 3xj. ; Spirit.
Anisi, 3jss. ; Olei Caryoph., Ttlj- ; Sirupi Zingib., 3S3.
M Fiat Haustus.

Form. 821. Haustus Sedativus et Refrioerans.
ft Potass^ Nitratis, gr. x. ; Tinct. Opii, Itlvj. ; Sirupi Pa-
pav. Alb., 3ij. ; Mist. Camphora;, 3x. Misce. Fiat
Haustus, omni 6t& hur& sumendus.

Form. 822. Haustus Tonicus Alkalinus. »
ft Potassu! Bicarbonatis, 3j. ; Infusi Gentianae Compos.,
Aq. PimeiitiE, 55, 3vj. ; Tinct. Rhei, 3j. M. FiatHaos-
tus, meridie ot borft somni sumendus.

ADDENDA TO APPENDIX.— Infcsom—Mistura.

XXXI

Form. 823. Infusum Angelic* Svlvestris.
B Railicis Angfilic. Sylvest., Calam. Aromatici, aS, 3iij. ;

infundo cum Aq. Font. Ferveiitis, 5vj. Stent per ho-

rnni in vase clauso ; cola, ct adde Liquoris Amnion.

Acctat., 3s». ; .lEtheris Sulphur., 3jss. ; Sirupi Curt.

Aurantii, Jiij. M. Fiat Mist. Capiat leger quaiibet

hora cochleare unum.

Form. 824. Infusum Anisi Compositum.
ft Seminuin Anisi, 3jss. ; Foliorum Melissae Oflicinalis,

3j. ; Aq. Communis Calida;, Ibij. Infunde per quad-

rantera horie ; cola, et adde Sacchari Albi quantum

libet.

Form. 825. Infusum Gall*.^
ft Gallnrum contus., Jij. ; Aq. Ferventis, Ibj. Macera per
huras vigiuti quatuor, et cola.

Form. 826. Infusum Serpentari*.
ft Radicis Serpentaris, 3iij. ; infunde cum Aq. Ferventis,
5viij., ebull. paul. Cola, et adde .lEther. Sulpliur.,
31J. ; Tinct. Camphorie Comp., 3j. M. Capiat leger
quiklibct hori cochleare unum.

Form. 827. Infusum Turionum Pini Adietis.
ft Turionis Pini Abietis, 3iij. ; infunde Aq. Fervid., fx. per
semi-horani ; dein exprime, cola, et adde vel Potassce
Carb., vel Potassie Sulphatem, vel Spir. .either. Nit.,
vel Sp. Junip. Comp., ut sit occasio.

Form. 828. Injectio Astrinoens.
ft Quercds Cort. cont., 3vj. ; Aq. Destil., 51. Coque per

partem horae sextam, et cola,
ft Liquoris Colati, 5iv. ; Infusi Lini, f iv. ; Extr. Conii,

3jss. ; Biboratis Sodae, 3]. M.

Form. 829. LiNCTUs cum Ipecacuanha.
ft Olei Amygdalarum, Sirupi Limonum, sing., 5J.j Pulveris
Ipecac, gr. vj. ; Confectionis Rose Caninae, 5J. ; Pulv.
Tragacanth. Comp., 3iij. Misce. Cochleare minimum
subiude deglutiatur.

Form. 830. Linctus Refrigerans.
ft Pulpffi Tamarindorum, Sirup. Althseae, 5a, fij. ; Potassae
Bilart., 3ijss. ; Potassae Nitratis, 3jss. M. Sumat omni
trihorio duo cochlearia parva.

Form. 831. Linctus TEBEsiNTHiNiE.
ft Olei Terebinth., 3ij.-fj. ; Mellis Despumati, ?j.-jijss. ;
Pulv. Radicis Glycyrrh., q. s., ut fiat Linctus, de quo
sumatur cochleare parvum vel medium, nocte, mane
meridieque.

Form. 832. Linimentum Opiatum.
ft Tinct. Opii Comp., fss. ; Camphorse, 3ij. ; Olei Amygdal.
Dulc, 5ij. M. Sit Linimentum.

Form. 833. Loxio Acidi Hydrocyanici.
ft Acidi Hydrocyanici, 3i.i. ; Plumbi Acetatis, gr. xvj. ; Aq.
Destill., fvijss. ; Spirit. Vin. Rect., 3ij. Fiat Lotio,
parti affectie applicanda. (Thompson, in Cutaneous
Eruptions.)

Form. 834. Lotio Acidi Nitro-Hydrochlorici.
ft Acidi Nitro-Hydrochlor. Diluti (F. 5), 3ij.-fss. ; Aq. Ca-
lidie, '^xyj. M. Fiat Lotio, quamprinium pra;parata,
sit, ope spongis, utenda.

Form. 835. Mistura Alkalina Anodyna.
ft Sodie Sesquicarbonatis, 3j. (vel Potassae Bicarb., gr.
xvj.) ; Misturae Amygdalarum, jjss. ; Tinct. Hyoscya-
mi, 1Tlxx.-3ss. ; Tinct. Cardam. Comp., 338. Fiat
Haustus, bis vel ter die sumendus.

Form. 836. Mistura Ammoniaci et Conii.
ft Acidi Nitrici, 3j. ; Aq. Pulegii, 3iv. Misce ; dein tere
cum Ammoniaci, 3j., et adde Extr. Conii, 3ss. ; Sirupi
Tulutaniifss. M. Capiat coch. unum in Decocto Al-
thaeie, &c.

Form. 837. Mistura Anodyna.
ft Aq. Menlh. Virid., fvjss. ; Potassae Nitratis, 3ij. ; Spirit,
.illheris Nit., 3ij. ; Tinct. Hyoscyaini, 3jss. ; Succi
Inspiss.iti Samb. Nig., 3jss. ; Exlracti Taraxaci, Sirupi
Aurantii, aa, 3ij. M. Fiat Mist., cujus capiat cochle-
aria duo larga, ter quotidie.

Form. 838. Mistura Ante Cardialgiam.
ft MngnesiiB, 3j. ; Aq. Anethi, J'vss. ; PotassiE Nitratis,
3jss. ; Liquor. Potass<£, 3j. ; Tinct. Calumbs, 3ij. ;

Spirit. Carui et Spirit. Anisi, Sil, 3ijss. ; Tinct. Lavand..
Comp., 3j. ; Sirupi Zingibcns, 31J. Misce. Capiat
coi:lileare unum aniplum subinde in cyatho Decoct.
Ilordei Comp., prius agilatil phial^.

Form. 839. Mistura Anti-Dysenterica. (I.)
ft JElher. Sulphurici, 3ij. ; Tinct. Opii Comp., 3iij. ; Sac-
chari Alb., ?ss. ; Gum. Acacie, 3ijs8. ; Olei Anthemi-
dis, Ttlxv. ; lExlr. Iluinuli, 3jss. ; Extr. Catechu, 3j. ;
Pulv. CanelliS Cort., 3j. ; Aq. Menth. Virid., fvjss.
Misce bene. Capiat cochlearia duo, tertiis vel quartii
horis.

Form. 840. Mistura Anti-Dysenterica. (2.)
ft Mist. CamphoraB, fv. ; Liq. Ammon. Acet., 5'j- i Spirit,
^ther. Nit., 3ijss. ; Vini Ipecac, 3ijss. ; Tinct. Hu-
mull, 3ijss. ; Extr. Humuli, 3j. ; Sirupi Papaveris, 3iij
M. Fiat Mist., cujus capiat cochlearia duo larga, ter-
tiu qu^que horil.

Form. 841. Mistura Anti-Icterica.
ft PotassiE Acetat., Extracti Taraxaci, 5a, jss. ; Extr. Conii,
gr. x.-xx. ; Aq. FtEniculi, Jvjss. ; Sirupi Sarzae et Si-
rupi Sennae, 55, jss. M. Capiat cochlear, ij. vel iij.
ampla, 4tis horis.

Form. 842. Mistura Asafcetidje et Conii.
ft Asafoetidie, 3ij. ; solve in Liquoris Ammon. Acet., 5Jss. ;
Aq. Fccuiculi, f iijss. ; Extr. Conii, 3j.-3ss. ; Sirupi
Senegae, Jss. Slisce.

Form. 843. Mistura Balsami Peruviani Comp.
ft Balsami Peruviani Ver., 3ij. ; Mellis Despumati, 3vj.
Misce, et adde gradatim. Mist. Myrrha; (F. 422), Jvj. ;
Tinct. Aurantii, §j. M. Fiat Alistura, cujus capiat
coch. j. ad iij., ter quaterve in die.

Form. 844. Mistura Beeladonn«.
ft Extracti Fol. Belladonnae, gr. ij. ad iv. ; Mnschi Optimi,
gr. vj. ad xij. ; Sacchari Albi, satis qiianlum ut tereiido
oblineatur pulvis congener ; delude adde, paulatira
miscendo, Iiifusi Frigidi Rad. Valeriana, jiv. ; Spirit.
-3i;ther. Sulphur. Comp., 3j.; Sirupi Papaveris, 3iij.
M. Capiat aeger cochlear, ij. vel iij. larga, 3tiis, 5tis,
vel 6tis horis.

Form. 845. Mistura Camphor-e Ammoniata.
ft CamphoriB, 3j. ; Alcoholis, lllvj. ; tere, et adde Moschi,
3ss. ; tere cum Sacchari Albi, 3j. ; Mist. Amygdal.
Dulc, fiv. ; Spirit. Amnion. Arom., 3ij. ; Sirupi Au-
rantii, f ss. M. Capiat fss.-fj., 4tis horis.

Form. 846. Mistura Cardiaca.
ft Potassae Bicarbonatis, 3jss. ; Mist. Camphorae, f vss. ;
Confectionis Aromaticae, 3ij. ; Spiritfis Myristicae, f js.
M. Fiat Mistura, cujus suniantur cochlearia tria ain-
pla cum cochlear! uno Succi Limonum recentis, in actu
effervescentiae.

Form. 847. Mistura Chloratis Potassje et SoDi.
ft Liq. Sodae Chlorinat., fss. ; Aq. Destil., fiv. ; Potassae
Chloratis, 3j. ; Aq. Pimentffi, fiijss. M. Capiat coch.
j.-iij., 2dis, Siiis, vel 4tis horis.

Form. 848. Mistura Cinchona: cum Acido.
R' Infusi Cinchonae, f vij. ; Acidi Hydrochlorici Diluti, 3j. ;
Tinct. Capsici, 3ss. ; Tinct. Croci vel Serpentariae,
3iij. ; Sirupi Papaveris, Jijss. M. Fiat Mist., cujus
capiat coch. ij. vel iii. ampla, 4t& q. q. horft.

Form. 849. Mistur.e Cinchonje et Acidi Sulph.
ft Decocti Cinchonae, fvss. ; Acidi Sulphur. Aroniat., 3J. ;
Tinct. Opii, Tllxxx. M. Capiat tertiam partem ter
quotidie.

Form. 850. Mistura CopaiBjE.
ft Copaiba) Ver., 3iij. ; Mucilaginis Acaciae Ver., fjss.
Misce. Adde gradatim, Aq. Cinnamomi, fiijss. ; Sods
Carbonatis, 3j. ; Tinct. Lavandulae CompositE, jij. ;
Tinct. Opii, 3j. ad 3jss. Misce. Fiat Mistura, cujus
capiat unc. j., ter quaterve in die, agitata phialA.

Form. 851. Mistura Cydonije Infusi Comp.

ft Seminum Cydoniae contus., 3ij. ; Radicis Glycyrrh. con-
tus., 5J. ; Fici Caricae FructOs, Jj. ; Aq., Oj. Coque
leni igne per partem horie sextam ; dein cola.

ft IIujus Decocti, 5VJSS. ; Potassae Bilart., 3ij. ; Biboratis
Sod<e, 3j. ; Spirit. JEther. Nit., 3ij. ; Sirupi Mori vel
Sir. Limonis, f ss. M. Fiat Mist.

Form. 852. Mistura Decocti Cinciion/e.
ft Decocti Cinchonae, Jvss. ; Tinct. Cinchonae, 3iij. ; Con-
feet. Arom., 3jss. ; Spirit. Ammon. Arom., 3jss. M.

Form. 853. Mistura Decocti Genist*.
ft Scoparii Cacumin., 5J. ; Aquae, Oj. ; coque ad 3viij., et

ADDENDA TO APPENDIX.— Mistura— Pilule.

adde Acetatis Potasss, Sijss. ; Spirit. Juniper! Comp.,
3vj. M. Capiat coch. ij. vel iij. larga, ter quotidie.

Form. 854. Mistura Diaphoretica.
R Vini Ipecac, Jjss. : Spirit. j9Ether. Nit., 3ijss. ; Liq. Am-
mon. Acet., ^ij. ; Liq. Antimon. Pot. -Tart., Jjss. ; Mist.
Camphora;, ?ivss. ; Sirupi Papaveris, jiij. M. Capiat
cochlear, j. vel ij. tertid quaque hora.

Form. 655. Mistura Diaphoretica Anodyna.
R Mist. Superscript. (F. 854), §vijss. ; Tinct. Hyoscyami,
3jss. (vol Tinct. Caiupb. Coinp., 3vj., vel Extr. Couii,
3SS.) Fiat Mist.

Form. 856. MisTURx CCM Dioitale et Kerm. Miner.

R Kermis Mineral., gr. vj. ; Muoilag. Acacice, ^i'j- ; Infusi
Digitalis, fiv. ; Sirupi Althaea), fj. M. Capiat coch-
leare unum amp. omni bihorio. (In Pneumonia, Pleu-
risy, &c., by Brera.)

Form. 857. Mistura Expectorans.
R Asafoetids, 3ijss. ; trituratione solve in Aq. Menth. Virid.,
fivss. ; et adde Vini Ipecac, 3j. ; Spirit. JEilier. Nit.,
3ij. ; Tinct. Castorei, 3ij. ; Sirupi Tolutani, 5J. Fiat
Mist., cujus capiat cochleare unum amplum, 2dis vel
3tiis horis.

Form. 858. Mistura cum Potassii Iodido et Acido
Hydrocyanico.
R Aq. Destil., fivss. ; Solutionis Potassii lodidi, Ttlxv. ;
Acidi Hydrocyanici Medicin., Itl.x.-xij. ; Extracti I.ac-
tuca;, gr. xij. ; Sirupi Althaea;, fj. M. Capiat 3ij.-3iij.
omni hora, vel f ss. omni bihorio.

Form. 859. Mistura contra Hydropem.
R Fol. Digitalis, 3j. ; Corticis Cinchona Pulv., 3vj. ; Aq.
Ferventis, jxij. Macera per horam, et cola. Liquori
Colato adde PotasscE Bitart., 3iij. ; Biboratis Sods, 3j. ;
Tinct. Cinnam. Co., Spirit. Junip. Co., aa, 3iij. ; Tinct.
Opii Co., lUxxv. M. Capiat cochlearia duo larga, ter
quaterve quotidie. (Nearly as Auoustin.)

Form. 860. Mistura Infusi Anthemidis Comp.

R Flor. Anthemidis, 3ij. ; Pulv. Rad. Valerian., 3iij. ; in-
funde Aq. Fontan. CalidiE, Jviij. Macera paulisper, et
cola.

R Hujus Infusi, f vij. ; Tinct. Camph. Comp., Tinct. Cas-
torei, Sa, 3ij. ; Sirupi Aurantii, fss. M. Capiat aeger
qu&libet hora cochleare plenum.

Form. 861. Mistura Infusi Calumb^ et Hyoscyami.
R Infusi Calumbs, fvijss. ; Tinct. Hyoscyami, 3ij. ; Sodae

Carbon., 3]ss. ; Tinct. Aurant. Comp., 3ijss. M. f ss.

ter quaterve in die. (In Diseases of Irritability.)

Form. 862. Mistura Infusi Calumbj: Comp.
R Infusi Calumbs, ^iv. ; Aq. Menth. Piper, vel Aq. Anethi,
f iij. ; Spirit. Anisi, Jij. ; Liquoris Ammon. vel Liquor.
Potassae, 3ij. ; Sirupi Cort. Aurantii, Jss. M.

Form. 863. Mistura Infusi Valerian*.
R Infusi Valerian., f vss. ; Liq. Ammon. Acet., 5Jss. ; Liq.
Antimonii Pot.-Tart., 3jss. ; Tinct. Hyoscyami, 3jss. ;
Aq. Pimenta, jss. M. Fiat Mist., cujus capiat a;ger
altera quaque hora cochlearia duo.

Form. 864. Mistura Hydrochlor. Ammonia:.
R Ammon. Hydrochlor., 3jss. ; Acidi Hydrochlor., 3ss. ;
Decocti llordei Comp., tbj. M. Capiat cochlear, lij.
ampla, 2dis vel 3tiis horis.

Form. 865. Mistura Salina Sedativa.
R Potassse Nitratis, 3ss.-3ij. ; Soda; Carbon., 3j.-3ijss. ;
Mist. Camph., Aq. Menth. Virid., aa, fiijss. ; Extr. Hu-
niiili, 3ij. ; Sirupi Zingiberis, 3iij. M. Fiat Mist.
(Interdum adde Tinct. Hyoscyami, vel Tinct. Cam-
phors Co.)

Form. 866. Mistura Sedativa.
R Mucilaginis Acaciae, fj. ; Olei Amygdalarum, Sirupi Pa-
paveris Albi, aa, fss. ; Tinct. Hyoscyami, 3jss. ; Vini
Ipecac, 3ij. ; Aq. Destil., fvss. ; Acidi Citrici, q. s., ad
gralam acidulationem. Misce. Fiat Mist., cujus sumat
coch. unum medium subind^.

Form. 867. Mistura cum SoDiE Biborate.
R Mist. Camphoras, Aq. Anethi, 55, jijss. ; Biboratis Sods,
3ij. ; Viui Ipecac, 3jss. ; Sirupi Papaveris, 3js3. M.
Fiat Mist., cujus capiat cochlearia ii. vel iij. quartis
huris.

Form. 868. Mistura cum SoDiE Potassio-Tartrate.
R Sodae Pot ass io- Tart rat. pulver., 3vj. ; Mist. Amygdalae,

5ss. ; Spiritfls Myristica.-, fss. M. Sumat tertiam

partem, secundii qii&que hord.

Form. 869. Mistura Stomachica. (1.)
R Calumb* Radicis contus., 3ss. ; Calami Aromatici cont.,

3j. ; Capsici Annul Bac cont., gr. x. ; Aq. Ferventis,

fviij. Macera per horas duas ; demde cola.
R Liquoris Colati, fvss. ; Liquoris Potassie Carbon., 3ijss. ;

Tinct. Myrrhae, 3j. ; Extracti Conii, gr. xv. ; Sirupi

Cort. Aurantii, 3ij. M.

Form. 870. Mistura Stomachica. (2.)
R Infusi Cascarillae, fvij. ; Sodae Carbon., 3ijss. ; Tinct.
Calumbs!, jss. ; JEther. Sulphur., 3ij. ; Tinct. Aurantii
Co., 3iij. M. Fiat Mist., cujys capiat cochlear, ij.
larga, bis quotidid.

Form. 871. Mistura contra Tenesmum.
R Mist. Camph., fv. ; Liq. Ammon. Acet., fij. ; Vini Ipe-
cac, 3ij. ; Tinct. Humuli, 3ijss. ; Tinct. Camph. Com.,
fss. ; Extr. Humuli, 3SS. ; Sirupi Pa|iaveris, 3iij. M.
Fiat Mist., cujus capiat cochlearia diio Ixrga, terti^
qudque hord.

Form. 672. Mistura Tonico-Aperiens.
R Decocti Cinchonae, Infus. Senriae, aa, jiijss. : Potassae
Sulphatis, 3iijss. ; Tinct. Sennae, fss. M. Fiat Mist.,
cujus capiat cochlear, iij. larga, bis quotidiu.

Form. 873. Mistura Tonico-Deobstruens,
R Extr. Taraxaci, 3iij. ; Extr. Gentianae, 3j. ; Soda; Car-
bon., 3j. ; Aq. Aurantii, fvij. ; Spirit, .^ther. Sulph.
Co., Sirupi Rosffi, aa, fss. M. Capiat f j.-5jss.,ter die

Form. 874. Mistura Zinci Composita.
R Zinci Sulphatis, gr. iv. ad vj. ; Infus. Rosae Comp., f vij. ,
Vini Ipecac, Jjss. ; Extr. Lactucae, 3jss. ; Sirupi To-
lutani, 3ij. M. Fiat Mist., cujus capiat cochleare
unum vel duo larga, tertiis vel quartis horis.

Form. 875. Mistura Zinci Opiata.
R Aq. Rnsse, Aq. Cinnamom., 55, f iijss. ; Zinci Sulphatis,
gr. vij. : Tmct. Opii, TUxxxvj. ; Tinct. Cinnamom. Co.,
3ij.; Sirupi Aurantii, 3jss. M. Fiat Mist., cujus ca-
piat cochlearia ij. ampla, bis die.

Form. 876. Pilule Alkaline; Anodynje.
R SodsB Carbon, exsic, 3j. ; Saponis Duri, 3j. ; Extracti
Hyoscyami, 3ss. ; Olei Jump., q. s. M. Fiant Pilul.
xl., quarum capiat binas vel tres omni nocte. (For
Nephritic and Calculous Affections.)

Form. 877. Piluls Aloes cum Ferro Composite:.
R Aloes, 3ij. ; Asaftetidae et Myrrhae, 55, 3ss. ; Ferri Sul-
phatis, 3j. ; Caryopbyllorum m pulv., 3j. ; Pulv. Cap-
sici, gr. xxvj. ; Bals. Canad., q. s. M. Fiant Pilul.
Ixvj., quarum capiat binas vel tres pro dose. (In Chlo-
rosis, &c )

Form. 878. Pilul* Anodyne:.
R Pulv. Jacobi Veri, gr. iij. ; Extr. Stramonii, gr. ss. ; Extr.
Hyoscyami (vel Conii), gr. iij. Fiant Pilul. ij., hoii
somni sumendae. (In painful Cutaneous Eruptions.)

Form. 879. Tilvlje Anodyno-Alterativ*.
R Camph. rasae, gr. vj. ; Hydrarg. cum Cret4, gr. xij. ; Sodas
Carbon, exsic, gr. x. ; Pulv. Acaciae, gr. iv. ■ Extr.
Hyoscyami, gr. xv. ; Sir. Simp., q s. M. Fiant Pilul.
xij., quarum capiat tres stalim, et hor^ somni.

Form. 680. PiLULa: Aperientes.
R Pulv. Radicis Rhei, 3ss. ; Extracti AloiJs Aquosi, gr.
xviij. ; Saponis Medicati, 3ss. ; Sirupi Simp., q. s. M.
Fiant Pilul. xx., quarum sumantur binae vel tres, bis
in die.

Form. 881. PiLULiE Aperientes cum Hyoscyamo.
R Extracti Gentianae, 3ss. ; Extracti Colocynth. Comp.,
Sijss. ; Pulv. Ipecac, gr. viij. ; Pilul. Hydrarg., 3j. ;
Extr. Hyoscyami, 3ij. ; Saponis Castil.. gr. xij. M.
Fiat massa aqualis, et divide in Pilulas xxivj., quarum
capiat binas vel tres hora somni.

Form. 862. Pilulje Astringentes.
R Aluminis contriti, gr. v. ; Myristicae Nucl. contr., gr. iv. ;
Extr. Gentians, q. s. (vel adde etiara Opii Puri, gr. j.)
Fiant Pilul. duae pro dose.

Form. 883. Pilul* Belladonna Extracti et Cin-
chona.
R Extracti Belladonna, gr. j.ad ij. ; Extracti Cinchonae, 3j.
M. Fiant Pilul. viij. Capiat ij. titis horis.

Form. 884. Pilula Cambogia, Aloes, et Ammoniacl
R Cambogiae, Aloes, ct Ammoniaci, in pulvere, partes
•equales: solve in Aceto ; dein liquorem cola, et con-
sume donee crassitudinem idoneam habeat. Divide in

ADDENDA TO APPENDIX —Pilule— PuLvia.

XXXlll

Pilula* gT. iv. Capiat binas ad quatuor pro dose. (Diu-
retic, Purgative.)

Form. 885. Pilulje Campiiob* et Ammoniaci.
R Masss Pilul. AloSs cum Myrrha, 3j. ; Gumnii Ammoni-
aci, 3j. ; Camphorie, gr. x. ; Sirupi Simplicis, q. s.
Misce. Fiant Pilul. xx. Oniiii mune capiat tres vel
quaiuor. (Stoll.)

Form. 886. PiLULs CAMPHORiE et Opii.
R Camphors, Potassa Nitratis, 59, Jij. ; Saponis Hispan.,
?ss. ; Extr. Opii Aquos., 3ss. ; Sirupi Tolutani, q. s.
M. Fiant Pilul. cxx., quarum binas vel tres ter quo-
tidie capiat. (Cadet de Gassicourt.)

Form. 887. Pilul* Camphor* et Quinin*.
R Camph. rasa;, 3j. ; Qnina; Sulphatis, 3ij. ; Massa Pilul.
AloSs cum Myrrhft, 3jss. ; Sirupi Ziiigiberis, q. s. M.
Fiat massa squalls, ct divide iu Pilulas xixviij., qua-
rum capiat anam bis quotidie.

Form. 888. Pilul* Chalybeat*.
R Ferri Sesquioxidi, f ss. ; Pulv. Canellie Albae, 3iij. ;
Alo«s Socot., 3js3. ; Sirupi Croci, q. s. M. Fiat massa
squalis.

Form. 889. Pilulje Colocynthidis cum Sulphur*.

R Extr. Colocynth. Corap., 3j. ; Sulphur. Sublimati, 3j. ;
PotassiE Sulphatis, 3iv. ; Sirupi, q. s. Divide in Pi-
lulas L.

Form. 890. Pilul* Colocynthidis Extk. et Hy-

OSCYAMI.

R Extract! Colocynth. Compos., 3ij. ; Extract. Hyoscyami,
3j. Misce, et divide in Pilulas lij. Suraat unant vel
duas pro re nat^.

Form. 891. Pilul* Deobstruentes. (1.)
R Saponis Venet., 3j. ; Pilul. Hydrarg., gr. viij.-xij. ; Gum-
mi Ammou., 353. ; Massae Pilul. Alogs cum Myrrhd,
3j. ; Terebinth., q. s. M. Fiant Pilul. xxx. Capiat
tres vel quatuor de die.

Form. 692. Pilul* Deobstruentes. (2.)
R Pulv. Gummi Guaiaci, 3j. ; Pulv. Gummi AmmoTiiaci,
3j. ; Amnion. Sesquicarbonatis, gr. xv. ; Massse Pilul.
Aloes cum Myrrh4, 3ijss. ; Tinct. Alo5s Conip., q. s.
M. Divide in Piluhis xl. ; e quibus sumantur tres ter
in die cum vasculo lufusi Anthemidis. (Altered from
Stoll.)

Form. 893. Pilul* Diuretic* et Antisfasm.
R Pulv. Fol. Digitalis, Pulv. Rati. Scillte, 55, gr. xij. ; Extr.
Hyoscyami, 3j. Divide in Pilulas xij. Capiat binas
tertiis horis. (Brera.)

Form. 894. Pilul* Diuretic* cum Hydrargyro.
R Gummi Ammoniaci, Extracti Taraxaci, Saponis Venet.,
55, 3j. ; Pulveris Scilla;, gr. vj. ; Pilul. Ilydrargyri,
gr. XV. ; Olei Junip., q. s. M. Fiant Pilul. xviij.

Form. 695. Pilul* Expectorantes.

R Pulveris Scillae. 3j. ; Ammoniaci Gum. Res., 3jss. ; Ex-
tract. Conii, 3ij. Contunde siniul, et divide massam
iu Pilulas lequales triginta ; quarwin siimat duas sextis
horis. (In Aiithma and Chronic Catarrh.)

Form. 896. Pilul* Gentian* et Aloes.
ft Aloes Ext. Purif., Genlianae Extr., ail, 3j. ; Saponis Cas-
til., 3jss. M. Divide m Pilulas xxxvj. Capiat uuam
ad tres pro re nat^.

Form. 897. Pilul* Guaiaci et Aconiti.
R Ext. Aconiti, gr. j. ; Pulv. Guaiaci, gr. viij. ; Olei Caje-
puti, q. s., ut iiant Pil. ij. Capiat unam mane nocteque.

Form. 898. PlLUt* Humuli Comp.
R Ammon. Sesquicsrb., gr. vj. ; Extr. Rhei, gr. viij. ; Extr.
Hiimuli, gr. xij. M. Fiant Pilul. vj., quarum capiat
tres horft somni.

Form. 899. Pilul* Hydraroyri Composit*.
R Pilul. Ilyd. Chlorid. Comp., 3ss. ; Pulv. Jacobi Veri, gr.
xij. ; Extracti Conii, gr. xxij. ; Saponis Castil., gr. vj.
Contunde simul, et divide massam in Pilulas xij.
iequales, quarum binx oniiii nocte sumantur.

Form 900. Pilul* Ipecacuanh* Comp.
R Pulv. Ipecac, gr. vj. ; Pulv. Ipecac. Comp., Extr. Papa-
veris, aa, 3j ; Extr. Humuli, 36s. ; Olei Anisi, q. s.
M. Fiant Pilul. xxiv, quarum capiat unam quartis ho-
ris, vel binas aut tres hur^ somni.

Form. 901. Pilul* Morphi* et Ferri Sulphatis.
R Sulphatis Morphiie, gr. ij. ; Olei Amygdal., q. s. ; ad
solut. dein adde Fern Sulphatis, gr. vj. ; Pulv. Glycyr.,

gr. viij. ; Mellis, q. s., ul fiant Pilul. viij. Capiat unam
terti& quiique hor&.

Form. 902. Pii.uL* Morphi* Hydhochloratis.

R llydrochloratis Morphiie, gr. j. ; Pulv. Ipecac, gr. iij. ;
Extr. Aconiti, gr. vj. ; Olei Amygdal. Dili., Hlvj. ; Pulv.
Glycyrrh. et Mellis, 55, q. s., ut tiant Pilul. viij. Ca-
piat unam Stiis vel 4tis horis.

Form. 903. Pilul* Moschi Composit*.
R Moschi, Potassx Nitratis, 5a, gr. vj. ; Caroph. rass, gr.
vj. ; Conserv. Rus., q. s. Fiant Pilul. vj.

Form. 904. Pilul* Calcii Chloridi et Conii.

R Calcii Chloridi, gr. ij. ; Extr. Conii, gr. iij. -v. Fiant Pi-
lul. dua', bis in die suineudie. (In Scrululous Obstruc-
tions.)

Form. 905. Pilul* Nervin*. (1.)
R Asafo^tidiE, 353. ; Castorei, gr. vj. ; Extract. Hyoscyami,
gr. X. ; Extract. Anthemidis, 3j. ; Sirupi Papaveris.q. ».
M. Fiant Pilul. xij. Capiat a;gra duas luaiie nocteque.

Form. 906. PiLUL* Nervin*. (2.)
R AsafoitidiE, 3ij. ; Camph. SubactiE, gr. xvj. ; Moschi, gr.
vj. ; Mucilag. AcaciiE, q. s. M. Fiant Pilul. xvj., e
quibus sumatur una omni bihorio.

Form. 907. Pilul* Nucis Vomic* et Aloes.
R Pilul. Aloes cum Myrrhft, 3iv. ; Extracti Nucis VomicK,
gr. X. M. Fiant Pilul. xxxvj., quarum capiat unam ad
duas, mane nocteque.

Form. 908. Pilul* Sarz* Composit*.
H; MassiB Pilul. Hydrarg., gr. viij. ; Extr. Taraxaci, Extr.
Sarz£, aa, 3v. M. Fiant Pilul. xlviij., quarum ca-
piat tres qualer in die.

Form. 909. Pilul* Scill* et Galbani Comp.
R Pilul. Galbani Comp., 3j. ; Pilul. Scillic Comp., 3ij. ;
01. Juniperi, Tl|,v. M. Divide in Pilul. xxiv., quarum
sumat bmas ter quotidi^.

Form. 910. PiLUL* Sod* cum Rheo et Hyoscyamo.
R Sodae Carbon, exsic, 3ijss. ; Pulv. Rhei, 3j. ; Extr. Hy-
oscyami, 3ij. M. Divide in Pilulas xxxvj., quarum,
ter quotidie, binae sumantur.

Form. 911. Pilul* Stomachic*.

R Pulveris Rhei, Pulveris Zingiberis, aS, 3ss. ; Extracti
Anthemidis, 3j. ; Olei Anisi, q. s. Fiat massa, in Pi-
lulas aequales triginta dividenda, quarum capiat tre^
ante prandium quotidi^. (In Dyspepsia and Chloro-
sis, &c.)
Form. 912. PiLUL* Sesquisulphureti Antimonii.

R Antimonii Sesquisulphuret. Crud., Extract. Dulcamara,
partes ajquales. Sint Pilul. gr. iij. Capiat iij. vel iv.
ter die.
Form. 913. PiLUL* Thkbaiac* Composit*.

R Gummi Ammoniaci, 3J. ; CamphoriE, Jss. ; Moschi Muse,
gr. XX. ; Pulv. Opii, gr. x. ; Bals. Peruviani, q. s. M.
Fiant Pil. gr. iij. Suniat lEger unam hor4 undecimd,
iterum vespere hor^ quinta ; et cubituni petens suioat
tres.

Form. 914. Pilul* Tonic*.
R Extracti Gentians, Pulv. Rhei, 55, 3ss. ; Saponis Castil.,
3j. M. Fiant Pilul. xviij., quarum sumantur binae ter
quotidie.

Form. 915. Potus Aperiens.
R Mannae, 5Jss. ; Potassae Bitart., fss. ; Seri Lactis, Oij.
M. Capiat cyathuin pro re natA.

Form. 916. Potus Tamarindorum Comp.
R PotassiE Tartratis, Pulp. Tamarind., Gum. Arab., 55, 5j.
Solve in Aq. Font. Fervid., ibij., et adde Oxymel. Simp.,
3'J- M-

Form. 917. PuLVis Ammoniaco-Camphoratus.
R Ammon. Sesqnicarbon., gr. iv. ; Camphorae pulveriz.,gr.
ij. ; Sacch. Albi, gr. xxiv. M. pro dose ; vel fiant Pil.
ij., cum Mucilag. Acacia;, oniisso Saccharo.

Form. 918. PuLvis A.nti-catarrhalis.
R Kermis Mineral., gr. iij. ; Florum Sulphuris, Pulv. Rad.
Glycyrrh., 5a, gr. xij. Fiat Pulvis, ter die suiuendus.
((JUARIN and Barthez.)

Form. 919. Pulvis Aperiens.
R Magnes. Carbon., 3ij- ; Potassae Bitart.. 3j. ; Pulv. Rhei,
Pulv. Rad. Glycyrrh., 55, gr. vj.-xij. Fiat Pulvis, omui
nocte sumendus iu thcriacil comniuui.

XXXIV

ADDENDA TO APPENDIX.— Pulvis—Vinum.

Form. 920. PuLVis Calumbs et Ferri.
R Ferri Potassio-Tiirtrat., gr. x.-xv. ; Pulv. Calumb*, gr.
XIJ.-3J- Fiat Pulvis, ter quotidi^ capiendas.

Form. 921. PuLVis Camphors: et Antimonii.
R Camph. rasE, gr. xvj. ; Potasss Tartratis, 3j. ; Antitnon.
Pot.-Tartrat., gr. j. M. Probe, et in chartulasviij. di-
vide i quarum sumatur una, terlia. quaque hora.

Form. 922. Pulvis Diaphoreticus.

R Kermis Mineralis, CamphorjB, aa, gr. iij. ; Gum. Acaciae,

Sacchar. Albi, aa, gr. viij. ; Olei Fceniculi, T!lj. M.

Form. 923. Pulvis Lientericus.
R Hydrarg. cum Cretft, gr. iij. ; Pulv. Ipecac. Comp., gr.
v|. ; Pulv. Rhei, gr. v. ; Pulv. Cinnamom., gr. vij. M.
Fiat Pulvis, bis vel ter die sumendus.

Form. 924. Pulvis Moschi Compositus.

R Moschi, gr. vj.-xij.
phoriE, gr. vj. M.

Pulv. Rad. Valerian., 3j.
Fiat Pulvis.

Form. 925. Pulvis Myrriij: et Ipecacuanha.

R Pulv. Myrrhae, gr. xvj. ; Pulv. Ipecac, gr. iv. ; Potassse
Nitratis in pulv., 3ij. ; Pulv. Opii, gr. j. Misce bene,
et divide in doses sequales quatuor. Capiat unam quar-
ta quSlque hor4.

Form. 926. Pulvis pro Torminibus.
R Magnes., Sacchari Albi, aa, gr. viij. ; Pulv. Canellae Cor-
ticis, gr. ij. M. Fiant Pulvis.

Form. 927. Pulvis Resolvens. (Stahlii.)
R Pulv. Antimonii Comp., Potass® Nitrat., Ocul. Cancror.
Pj-sep., aa, 3j. ; tere bene siuiul. Dosis 3j.

Form. 928. Pulvis Salinus.
R PotassiE Chloratis, gr. v.-xij. ; Sodii Chlnridi, gr. viij.-xx.
SodiB Sesquicarbonatis, gr. x.-xv. ; Olei Pimentce, vel
Cajeputi, vel Sine, Ulij.-v. M Fiat Pulvis pro re
nati sumendus in decocto Ilordei vel jusculo Bovino.

Form. 929. Pulvis Sod*: Nitratis Compositus.

R Sods Nitratis, gr. v.-3j. ; Pulv. Cinnam., gr. vj. ; Pulv.
Ipecac, gr. ss.-j. ; Olei Piment:E, Ttlj. M. Fiat Pulvis,
ter quaterve in die sumendus. (For Diarrhoea, Dys-
entery.)

Form. 930. Pulvis Valerianje Compositvs.

R Pulv. Rad. Valerian., 3j.-3ij. ; Magnes., Ammon. Hy-
drochlor., aa, gr. v. ; Olei Cajeputi, Tllij. M

Form. 931. SoLUTio Belladonns Extkacti.
R Extracti BelladonnE, 3j. ; Aq. DestiUat., f j. M. Fiat
Solutio.

Form. 932. Solutio CAMBOoia; Alkalina.
R Gum. Res. Cambogise, jss. ; solve in Liquor. Carbon. Po-
tass^, 5ss. Hujus solutionis capiat Tllx_\.,quater in die,
quuvis in vehiculo idoneo. (Both Diuretic and Calhal-
tic. Hamburgh Dispensatory.)

Form. 933. Solutio Hydro-Sulphatis Calcis.
A Hydrosu}phate of the Protoxide of Calcium.
R Sulphur. Pulveriz., ibj. ; Calcis Vivi, ftij. ; Aq. Fontans,
Ibxv. Coque per partem hor^ quartam,et cola. (PlEB-
quin's Antipsoric Milk. Hahnemann and Passing
recommend it as a gargle in salivation; and a dessert
or table-spoonful of it is to be taken internally in some
soup (mutton or veal broth), in cases of poisoning by-
mercurials.)

Form. 934. Solutio Refrioerans.
R Nitrat. PotassiE, fss. ; Ajnmon. Hydrochlor., 3iij. ; Aq.
Pur., Jviij. Solve leni cum calore, et adde Camphors
pulverizat., 3jss. ; Alcoholis, q. s. Macera. Capiat
3j.-3iij., in Decocti Hordei cyatho.

Form. 935. SiRUPUs Antimoniatos.
R Kermis Miner., 3j. ; Sirupi Scillae, Sirupi Althieje, aa,
Jjss. M. Capiat coch. j.-iij. minima, ter quaterve
ill die.

Form. 936. Tinctura Astringens.
R Catechu, Myrrhae, aa, ?ss. ; Pulv. Cinchonae, 3ij. ; Bal-
sami Peruvian., 3jss. ; Spirit. Armoracise Comp., Spirit.
Vmi Rectificati, aa, 5Jss. Misce, et digere. (For
Sponginess of the Gums.)

Form. 937. Tbochiscus Astringens.
R Catechu, ^ij. ; Moschi, 3ij. ; Sacchar. Albi, Jiijss. ; Mu-
cilag. G. Tragacanth., q. s. Misce. Fiant Trochisci par-
vuli. (For Relaxation of the Uvula, Hoarseness, &c.)

Form. 938. Unguenti Chlorureti Calcis.
R Chlorureti Calcis in pulv. subtil, redac, 3ijss. ; Turbith.
Mineral, in pulv., 3ij. Misce bene ; dein tere cum
Axung., Jijss. ; Olei Amygdal. Dulc, 5j. M. Fiat
Unguentum.

Form. 939. Vinum Ferri.
R Tincturffi Ferri Sesquichloridi, 3j. ; Vini Albi Hispan.
3XV. M.

INSANITY, CONNATE.

626

recovery of the patients. It is difficult, and
even not very requisite, were it easy, to state
the classifications and arrangements which may
be adopted in various circumstances. In these
matters, as well as in the organization and man-
agemenl of these institutions, medical knowledge,
and an acquaintance with mental disorders,
under the guidance of common sense, will
generally enable the physician to arrive at
judicious conclusions. But in all arrangements
and modes of organization, a due separation of
the different classes of cases, and of convales-
cents, should be secured ; and no asylum, pub-
lic or private, should be allowed or licensed
that is not placed under the constant superin-
tendence of a regularly educated and qualified
medical practitioner, who should reside in it,
and be in constant communication with its in-
mates. On this particular topic, much infor-
mation will be obtained in many of the recent
publications referred to in the Bibliography at-
tached to this article. I can furnish only a
brief abstract of what has been stated regard-
ing it by PiNKL, EsQuiROL, and Georget.

519. a. 7'Ac ck**(/ica<io« of lunatics is requi-
site, not merely for the purpose of separating
such as are liable to injure themselves or oth-
ers, but also with the view of permitting those
to associate together who may contribute to
each other's cure. A lunatic asylum should be
composed of several parts, more or less insu-
lated. There ought to be a quarter for each
sex ; a division for the violent ; a second for
those who are tranquil ; a third for those la-
bouring under accidental disorders or compli-
cations ; and a fourth for convalescents. It
is, above all, necessary to separate the sexes,
the convalescents, and those who have depra-
ved habits and indecent manners. Divisions
should also be allotted for those of melancholy
feelings ; for those in a state of imbecility or
dementia ; for the noisy and furious ; and for
those who are untameable, or are confined by
way of punishment. It would be preferable for
each division to have a court planted with trees,
and a garden for the patients to walk in.

520. b. It is farther requisite, for the con-
venience and safety of the patients, and to fa-
cilitate vigilant superintendence and protection,
that an asylum should be built on level or
slightly elevated ground ; that the cells for vio-
lent patients should be spacious, with a door
and wmdow opposite each other, and opening
from without ; that they should be boarded, and
not paved ; furnished with a bed firmly fixed in
the wall ; that all the cells should communi-
cate with covered galleries or corridors, in
which the patients may walk in bad weather,
and by means of which the inspectors and ser-
vants may easily pass to different parts of the
building ; that all the rooms should be warmed
by pipes containing hot water in preference to
hot air ; that water should be al)undanlly sup-
plied ; that the privies should be arranged so
as to occasion no inconvenience to the patients ;
and that there should be places appointed for a
general work-room, for a common dining-room,
for baths, shower baths, and douches. There
should be suitable dormitories for convales-
cents, melancholic patients, idiots, and those
who are debilitated. For others, little cells
with one bed are preferable ; the patients go-
ing out of them in the daytime, and associa-

II 79

ting with one another, no companions being
allowed in the night.

521. B. 'Ifie selection of the inspectors and at-
tendants in lunatic institutions is of great impor-
tance. Insane persons look upon the attend-
ants as accomplices in the power which has
deprived them of liberty, and as inhuman jailers,
view them with suspicion and hatred, and even
abuse and strike them. It is often difficult to
make servants understand the states of those
committed to their care, so as to enable them
to preserve their temper, and to act with kind-
ness and firmness in all circumstances ; and it
is not easy to convince them that the insane
have the use of some of their faculties, and are
often quick, observant, and cunning. Those
attendants who have been themselves insane
are generally the most careful, forbearing, and
kind to those over whom they are placed. M.
EsQuiROL has a favourable opinion of conva-
lescents as keepers : they are compassionate
to the infirmities which they have themselves
so recently suffered ; they aid the physician
more efficiently ; and their examples are en-
couraging to others. The attendants ought al-
ways to be sufficiently numerous — one attend-
ant to from eight to twelve male patients, and
one to from ten to fifteen females, according to
circumstances. Old military men are among
the best keepers ; for, as Dr. Conolly remarks,
they keep up their own authority, and are obe-
dient to superior orders. The physician of a
lunatic asylum ought to be careful to instruct
those who are to have the management of the
patients. It is absolutely requisite that a judi-
cious arrangement of authority and subordina-
tion be established in all asylums, and that the
power of the physician should be superior to
all, in respect of everything that concerns the
patients.

IX. Insanity, Connate; and Puerile Imbe-
cility. — Syn. Idiolcy, Natural Idiolism, Con-
genital Privation of Intellect, Puerile Imbecility,
Weakness of Mind, Silliness, Stupidity, Con-
nate Fatuity, Primary Fatuity, Idiotism, Men-
tal Deficiency, Original Deficiency of Under-
standing ; Stupiditas, Vecordia, Amentia, Imbe-

^ cillitas Ingenii ; Fatuitas ; Amentia Congenita,
Sauvages, Sagar, Vogel ; Dimence innee, Fo-
dere ; Idiotisme, Pinel ; Die Spracheigenheit,
Bitidsinn, Germ. ; Idiotismo, Ital.

522. Defin. — Deficiency or entire privation of
intellect, appearing during infancy and childhood,
depending either upon an original defect, or upon
an arrest of the development of the mental facul-
ties.

523. Puerile imbecility and idiotcy may be con-
sidered as representing two grades of primary
mental deficiency. The former is that state or
degree in which there is an original impairment,
but not an entire want of intellect. The latter
is a more complete grade of deficiency, some-
times amounting to an absence not only of the
moral and intellectual manifestations, but also
of the instincts necessary to self preservation.
Between, however, this, the highest degree of
idiotcy, and the slightest state of intellectual
deficiency, there is every intermediate grade.
Original defect of intellect should not be con-
founded with the imbecility, or incolierency, or
fatuity consequent upon other forms of insani-
ty, or upon cerebral diseases — the Amentia ac-
quisita of authors ; nor with senile fatuity, ica-

626

INSANITY, IDIOTIC— Grades ov.

. becility, or dotage — the Amentia senilis. The
distinction has been very properly made by Es-
QuiROL and Prichard ; and most succinctly and
correctly stated by Dr. Klein Grant, under the
article Amentia, in his edition of Hooper's Med-
ical Dictionary. Original deficiency and entire
want of intellect may appear unconnected with
any bodily disease ; may be simple and uncom-
plicated ; or they may be associated with other
maladies, or complicated. Complete idiotcy, es-
pecially, may be farther associated with con-
genital deficiency of some organ or part, or
connected with malformation, or arrest of de-
velopment of some portion of the brain, or or-
gan of sense.

524. i. Deficiency of Intellect appears in
every grade and form until it amounts to com-
plete idiotcy. The slighter degrees of deficiency
are manifested chiefly by weakness of charac-
ter and capacity, or by stupidity or deficiency of
the powers of perception, or of the understand-
ing. These grades of defect are generally not
sufficient to render an individual incompetent to
the management of his affairs, or to conduct
himself with propriety, and are hence not con-
sidered sufficient to constitute unsoundness of
mind, in its legal acceptation. But as the origi-
nal defect may present every grade, from the
slightest of those just mentioned to complete id-
iotcy, it is difficult to draw any line of demarca-
tion between what maybe considered soundness
or unsoundness of mind. This line must still
remain unfixed, or at best be only conventional",
for no standard or criterion can possibly be es-
tablished. As in consecutive impairment or
disorder of mind, so in original deficiency of
intellect, there are every shade and degree of
mental manifestation, descending from the high-
est state of perfection of the human understand-
ing down to the lowest state of privation of
intellect and of instinct ; there being no break
in the scale, or in the continuity of declension.

525. Deficiency of intellect begins to appear
from the Jirst to the eighth or ninth year of age.
When it is congenital, it may manifest itself
even somewhat earlier than the former period.
When it arises from an arrest of the develop-
ment of the mental faculties, owing to injury
or physical disease, it may not be evinced until
a later period than that assigned. In this lat-
ter case, the deficiency is seldom so great as
when it occurs at earlier stages, or depends
upon changes that have taken place in the en-
cephalon either previous to or soon after birth.

526. From what has been already stated, it
is obvious that all the grades and forms of ori-
ginal imbecility cannot be described within mod-
erate limits. Nor is minute description at all
requisite : the works of Georget and Esquirol
will furnish it, and numerous illustrations of it.
I may, however, briefly observe, that imbecile
persons have a limited capacity for certain ac-
tions or employments, and acquire some de-
gree of facility in performing them. These
they generally execute in a tolerable manner,
while they are quite incapable of any other
modes of exertion or occupation. Habit has a
great influence on all their proceedings, and
gives to many of them an appearance of regu-
larity which may be mistaken for the result of
steadiness and of higher powers. All are, how-
ever, deficient in the powers of attention and
thought. They are generally timorous, often

docile, weak and inconstant in purpose, and
frequently irascible. The senses of some give
rise to feeble and dull impressions ; of others,
to more lively perceptions. Memory is strong
in some ; while in others it is weak, confined
in its range to the most ordinary objects and
frequently repeated ideas, or it hardly exists.
They display some indications of mind, of in-
tellectual faculties, and of feelings and aflfec-
tions ; and they have the use of speech and of
language generally in a degree proportionate to
the grade of perfection of their several senses
and mental powers. They show the same va-
rieties of character, inclination, and moral pro-
pensity, as persons of stronger understanding.
Left to themselves, they are careless, lazy, and
filthy. At the age of puberty, they evince the
animal instincts by the most offensive gestures,
habits, and solitary vices. Some become sub-
ject to paroxysms of capricious violence, to
hysteria, to nymphomania, or satyriasis. Many
are prone to lying, pilfering, and stealing. Sev-
eral lapse into melancholia, or sink in a grad-
ual decay of physical health — frequently owing
to an uncontrollable addiction to masturbation.
In other circumstances, they eat and digest well,
and females have the catamenia regularly.
Some imbecile persons evince signs of talent
in particular pursuits, particularly in music
and the ruder of the imitative arts. Others
have retentive memories, learn languages, and
are capable of other acquirements, while, in all
other respects, they are deficient in any talent,
and generally in mental power. They com-
monly present much of the character, in man-
ner and in the development of mind, of infants
or children. They are deficient in alTection, in
application to any pursuit, in the powers of
comprehension, of pursuing a train of ideas,
and of entering into a rational or sustained
conversation. They are without energy and
steadiness, and are fearful and cowardly. They
are incapable of reflecting, of contriving any-
thing, or of accomplishing anything.

527. ii. Idiotcy. — More or less complete priva-
tion of the mental faculties. — This is the highest
grade of original deficiency of intellect. In
this state, the moral, the reflecting, and the in-
tellectual manifestations are altogether want-
ing ; and sometimes the instinctive emotions
of mind are also partially or totally undevelop-
ed. Indeed, the different states of idiotcy de-
pend chiefly upon the extent of deficiency of
this class of the mental powers. Those in-
stinctive feelings and desires which are the
most generally bestowed on the animal creation,
and which especially subserve the preservation
of the individual and of the species (see Classif.
in note to 6 66), are chiefly present — frequently
in an inordinate degree — and are deficient only
in the most extreme cases. Infants that be-
come idiots' have large or ill-formed heads, im-
perfect features, take the breast with difliculty,
are long before their eyes follow the light, and
often squint. They are puny, lean, of bad com-
plexion, have a feeble physical development
and vital endowment, are incapable of instruc-
tion, cannot learn to walk until they are six or
eight years of age, or sometimes till they attain
the age of puberty. They articulate imperfect-
ly, or learn but a few words, or are altogether
incapable of articulate sounds, although they
may possess the sense of hearing. When the

INSANITY, IDIOTIC— Causes of.

C27

head is very small or very large, or flattened in
any direction, or much deformed, death gener-
ally takes place early — generally long before pu-
berty, or at any age between this epoch and the
first months of existence.

528. Idiots^ both children and adults, present
not only these deformities, but all those descri-
bed in the article Cranicm. Their features are
irregular and repulsive ; their eyes are blink-
ing, and deeply set ; their lips are large, thick,
flaccid, and relaxed ; their mouths are gaping,
and admit of a drivelling of the saliva ; their
organs of sense are imperfect — they see and
bear imperfectly, or are entirely deaf and dumb.
Their taste and smell are also deficient, and
they eat without selection of food. If speech
exist at all, it is extremely limited, and drawl-
ing or lisping, and capable of expressing only
the most urgent physical wants. Their chests
are narrow or contracted ; their limbs ill-form-
ed; and their gait, as well as 'all their move-
ments and attempts at muscular exertion, un-
steady and awkward. They are sometimes
club-footed, and the muscles of the arms or legs
contracted. They are commonly rachitic, or
scrofulous — often partially or generally para-
lytic, or subject to epileptic fits. Not only are
they without the reflecting and intellectual fac-
ulties, but even their sensibility is deficient ;
and sensation, when excited, is scarcely follow-
ed by perception of objects or ideas. They are
incapable of directing their attention to any-
thing. Owing to the defective state of their
instinctive feelings, they appear far below the
brutes in the scale of animal existence ; and,
as M. EsQuiROL remarks, are monsters or im-
perfect beings, who are destined to a speedy
extinction, if the tenderness of parents, or the
compassion of others, did not prolong their ex-
istence. Yet idiots have the bodily appetites
and sexual desires — sometimes in an inordinate
degree and repulsive manner. They often ex-
hibit signs of premature puberty, and are gen-
erally addicted to masturbation. They are
often, also, subject to anger and rage. Some
display faint glimmerings of intelligence, when
their notice is excited by strong impressions
on their senses. They then appear to look at
certain things with a vague expression of pleas-
ure, or of curiosity ; they seem to desire some
objects, particularly articles of food ; they occa-
sionally indicate, by gestures or cries, objects
of desire or aversion, or the pleasure or pain
which they feel ; they come to know the per-
sons who habitually take care of them ; but
they are incapable of dressing or undressing
themselves, or of the common acts of cleanli-
ness. Others are debased to the lowest state
of being — are sometimes even unconscious of
their evacuations, and incapable of command-
ing or restraining them ; and enjoy only a vege-
tative existence, devoid of sensation and sen-
sibility. Idiots of a higher grade of develop-
ment are capable of moving from place to place ;
but are, like machines, made to repeat the same
movements ; they move their arms, as if to fa-
cilitate progression ; laugh mechanically ; ut-
ter inarticulate sounds, as if to amuse them-
selves ; occasionally catch a few notes of a
simple tune, which they constantly repeat ; and
become attached to particular places and po-
sitions.
529. iii. The C CM PLicvTioNs of imbecility and

idiotcy are chiefly those already noticed ((> 523,
528), more particularly rickets, scrofula, gener-
al or partial palsy, epilepsy, contractions and
malformations of the extremities, deficiencies
of the organs of sense, goitre, and, still more
particularly. Cretinism, which, in its fully de-
veloped states, is always associated with more
or less absolute want of the mental powers.
(See art. Cretinism.)

530. iv. TheCAusEsof imbecility and idiotcy
are of importance, both in a medical and in a
social point of view. — A. The remote causes are,
1st. Those which are referable to the parents,
and which operate previously to birth ; 2dly.
Those which more especially belong to the pa-
tient, and which affect him subsequently to
birth. — a. The causes which operate previously to
birth are, whatever exhausts or debilitates the
parents, or renders the reproductive acts im-
perfect ;* as habitual debauchery, solitary vices,
and drunkenness ; sexual debility, or states ap-
proaching to impotency ; the insalubrity of cer-
tain localities, particularly those observed to
produce cretinism (<J 6) ; the scrofulous and
rickety diathesis ; and the advanced age or de-
bility of one or both parents. Esquirol states
that idiotcy is more common in the country —
especially in mountainous districts — than in
towns. He, as well as numerous other writers,
insists upon the influence of violent mental
emotions, and moral shocks during the early or
middle months of utero-gestation. Several
modern writers have affected to doubt this
cause ; and, as they cannot dispute the frequent
occurrence of arrest of development of the ner-
vous system, and congenital deficiency of men-
tal manifestations in the children whose moth-
ers had been thus affected during the period of
their foetal existence, yet consider the phenom-
ena in no way connected, as coincidences
merely, and as holding no relation of cause
and effect. The vulgar opinion, however, of
this matter is nearer the truth ; and the evi-
dence of the arrest of development having been
produced by the mental, and the consequent
physical shock of the mother during gestation,
is much more conclusive than most of the evi-
dence usually furnished us in physiological and
practical researches, or than that upon which
we are constantly acting in the discharge of our
professional duties. It by no means follows
that the phenomena which we cannot satisfac-
torily explain should therefore not exist, or
that relations of which we cannot trace the con-
nexion conclusively are on this account alto-
gether wanting. Yet, even here, however diffi-
cult maybe the explanation, or apparently loose
the connexion, both the one and the other may
be furnished conformably with views stated in
this and other articles. It is not improbable,
even, that the means sometimes used to con-
ceal pregnancy, or to procure abortion, may so
affect the development of the foetus as to pro-
duce idiotcy. The same causes which occasion

* A physician was consulted by a gentleman who was
anxious to marry, to secure a fortune in his family, but had
been some time deterred from marriage by a consciousness
of weakened sexual powers, consequent upon masturbation
in early life. As he was youn^, and his constitution had
apparently not suffered seriously, he was advised to marry,
under the conviction that a moderate exercise of the sexual
functions would assist in restoring their energies. The
advice was adopted ; but the first child that was born was
an idiot. The later children were sound : he had gradually
recovered his powers.

628

INSANITY, PUERPERAL— Description of.

congenital and chronic Dropsy of the Brain {()
283, et seq.) will sometimes cause more or less
complete deficiency of the mental fuculties.
Inflammation, or tubercular disease of the brain
or of its membranes during fcetal existence,
will disturb or arrest the subsequent develop-
ment of these parts, and of their respective
manifestations. Injuries of the head of the
fcEtus, sustained during parturition, have also
produced this effect.

531. b. The causes which operate after birth
are, chiefly, injuries of the head ; diseases of
the brain — particularly acute and chronic hy-
drocephalus ; inflammations of the brain or of
its membranes ; convulsions ; dentition ; ex-
anthematous fevers — especially when attended
by cerebral affections ; tubercular disease, with
or without inflammation of the encephalon ;
remarkable precocity in connexion with a sus-
ceptible and irritable state of the constitution ;
and very early addiction to the vice of mastur-
bation. This last cause is frequently produc-
tive of those states of imbecility, or slighter
forms of mental deficiency, observed at ad-
vanced stages of childhood, or near the ap-
proach of puberty. To these causes may be
added the use of improper coverings on>the
heads of infants and children, as ably illustrated
by M. FoviLLE {Deformat. du Crane result, de la
Meth. dc couvrier la Tete dcs Enfans. Paris,
1834.).

532. R. The pathological causes are chiefly
imperfect, deficient, or interrupted development
of the encephalon, and affecting it either par-
tially or generally ; sometimes associated \\'\i\\
changes of the consistence and form of the
brain, and not infrequently with some of the
usual consequences of old or previous inflam-
mation of the membranes — particularly the
arachnoid, and of the cerebral structure. Mor-
GAGNi and others found the brain harder than
natural. Meckel says that it is often drier,
lighter, and more friable than usual. Mala-
CARNE states, that the convolutions of the brain
are numerous in proportion to the intelligence,
and that in idiots they are always few. They
are very generally smaller, less prominent, and
less numerous in these persons ihan in others.
M. EsQuiROL has observed the lateral ventricles
uniformly very small in idiots. In some, one
hemisphere is much less developed than the
other; and, occasionally, one lobe is more de-
ficient than the rest. In these cases, one or
more limbs have been paralyzed. These defi-
ciencies have been more frequently observed
in the anterior than in the other lobes. The
cerebral substance is sometimes softened in one
part, and hardened in another. For farther de-
tails, see the articles Brain, Cranium, and
Epilepsy.*

* [The phenomena of i Jiotcy, at least, would seem to prove
that the mind is not independent of the brain, as maintained
above, as a very small brain is invariably a cause of idiotcy ;
and there is no instance on record where the mind has been
manifested vigorously by a very small brain. But idintcy
arises not only from deficiency of size, but also from disease
of the brain, or injuries, as already stated. Partial idiotcy
is also not unfrcquently met with where an individual man-
ifests one or several powers of the mind with an ordinary
degree oT energy, but is deprived, to a greater or less ex-
tent, of the power of manifesting all the others. Our coun-
tryman, Dr. Rush, has particularly called attention to this
partial development of certain mental powers in idiots, and
the partial possession of the moral faculties, a phenomenon
which, it would seem, can scarcely be reconciled with the
doctrine of a single organ of mind. J

533. V. The Treatment of imbecility and id-
iotcy is rather preventive than curative. Preven-
tion depends entirely upon the avoidance of the
remote causes, and upon the employment of
those means which tend to strengthen the
physical powers of the parents, and of the off-
spring after birth. That much is owing to
the constitutional powers of the parents, is
shown by numerous facts, and by the circum-
stance of several idiots or imbecile persons be-
ing often met with in one family. Attention
to the general health of the infant, good nur-
sing, daily cold ablutions, frictions of the sur-
face, a dry and temperate atmosphere, frequent
changes of air, and due promotion of the sev-
eral secretions and excretions, are the chief
means by which a healthy development of the
offspring of debilitated persons can be secured.
In every case, a strong, healthy, and young wet-
nurse should be procured immediately for the
infants of such parents. As dentition and child-
hood approach and advance, the means and the
cares advised in the articles Age and Denti-
tion are especially required. The cxirative
means are limited to physical and moral educa-
tion, which may be of use in the slightest forms
of imbecility, but which are of no avail in the
more manifest states, and in idiotcy.

X. Insanity, Puerperal. — Syn. Insania Puer-
perarum, Mania Puerperalis ; ' Puerperal Ma-
nia.

534. Defin. — Disorder or aberration of mind,
of either a partial or general form, occurring in
any period of the puerperal states.

535. i. Description. — Puerperal insanity may
appear in a slight or partial, or in a severe and
general form. It most frequently, however, as-
sumes the form of mania and melancholia. In
a few cases it presents a mixed character, or
that of melancholia alternating with mania. In-
sanity may occur, 1st. At any time from con-
ception to parturition — the insanity of pregnan-
cy — Insania gravidarum ; 2dly. From parturition
to about three weeks or a month subsequently
— the insanity of parturition — Insania post par-
turn ; 3dly. At any period during lactation, or
soon after weaning — the insanity of lactation —
Insania lactanlium. In the first of these peri-
ods, it is usually slight or partial, chiefly affect-
ing either the moral manifestations or the un-
derstanding. In the second, it most frequently
assumes the form of acute mania, sometimes
passing into a chronic state, but rarely assu-
ming the character of dementia or fatuity. In
the third, melancholia, slighter forms of mania,
and partial insanity are the most common. Any
of these states of disorder, occurring in any of
the periods now specified, may be simple or com-
plicated, in respect of succession, or co-exist-
ence with some other malady, particularly hys-
teric affections, epilepsy, convulsions, catalepsy and
cataleptic ecstasy, uterine hccmorrhage, disease of
the uterus or ovaria.

536. A. Insanity during Pregnancy — Insania
Gravidarum. — Pregnancy generally occasions
more or less excitement of the nervous and
vascular systems ; and sometimes gives rise to
various morbid impulses or aberrations of mind,
especially in females hereditarily predisposq^} to
insanity. The mental disorder may appear im-
mediately upon conception, and disappear on
quickening ; or it may occur at any period of
utero-gestation, continue through, and cease

INSANITY, PUERPERAL— Description op.

629

upon delivery, or it may persist through all the
circumstances consequent upon parturition. In
this latter case, however, it seldom retains the
same form or character, but passes into one
more general or severe ; melancholia, or any
otiier partial disorder, being aggravated into
mania. In some cases, the mental affection
coiiunences as hysteria, or in some one or oth-
er of its numerous states ; and in two cases in
which I was consulted, it was preceded by cat-
alepsy and cataleptic ecstasy — affections inti-
mately allied to hysteria.

537. The most frequent states of mental dis-
order observed in this period are melancholia,
and the moral disorders described above (I) 69, ct
seq). Tlie singular feelings and desires, the
whims and caprices frequently attending this
state, cannot be considered as amounting to in-
sanity, inasmuch as they seldom engross the
mind, or withdraw it from all other thoughts
and pursuits, or overwhelm the natural feelings,
or influence the conduct. As soon, however,
as any singular desire exercises such a sway
as this — when it engages the mind and influ-
ences the conduct, uncontrolled by natural sen-
timents and requisite occupations — it then
amounts to moral insanity, and requires both
moral and physical treatment. In some fe-
males, pregnancy occasions not only irrepress-
ible fears and melancholia, but also various dis-
ordered impulses, productive of crime or vari-
ous unlawful acts, either before the control of
reason can be exercised, or in opposition to the
feeble efforts of the understanding {^ 92). In
unmarried females, the melancholic feelings,
the irrepressible fears, and the morbid impulses
of the mind are often heightened by shame, re-
morse, the abandonment of the seducer, the
consciousness of poverty, or the fears of ill
treatment. Under such affliction, the mind may 1
he so disordered as to perpetrate various crimes,
or even suicide. In this state, consciousness
may be lost for a time, and acts be committed,
before it be restored, of the most flagrant na-
ture, and the most repulsive to the natural dis-
position and feelings. This is the more likely to
occur if the mental distress be attended by fits
of kipothymia, or o{ fainting, or by convulsions .
In some cases, recovery from these attacks, or
the restoration of consciousness, is attended
by a short period of maniacal excitement, or a
slate of momentary delirium, during which su-
icide, murder, or incendiarism has been per-
j)etrated. In most cases of mental disorder oc-
curring during pregnancy, and in all that I have
seen, there was either an hereditary predispo-
sition to it, or the patient had been previously
subject to obstinate hysterical affections, and
had experienced overwhelming or intense emo-
tions of the miod.

538. B. Insanity after Delivery — Insania post
Parlitm — I'araphrosyne Puerperarum, Siuv.^cES.
— a. Insanity consequent upon parturition is
ofien preceded, during pregnancy, by harassing
fearsand unfavourable presentiments. In some
cases, various hysterical affections, preternat-
ural susceptibility, great exuberance or depres-
sion of spirits, suspicions, irritability, a state of
stupor or sopor, and slight or short attacks of
mental aberration, have occurred during gesta-
tion. Generally the disease appears from the
second or third day to the sixteenth or seven-
teenth ; but it may occur almost immediately

after parturition, or be delayed to the third or
fourth week. Some writers assign the third
and fourth, and the thirteenth, fourteenth, and
fifteentii days, as the most frequent periods of
its ap|)carance. The chance of an attack, how-
ever, progressively diminishes after the third
or fourth day. The disorder may commence
with want of sleep, inquietude, sadness, anxie-
ty, or ill-grounded fears respecting some mat-
ter ; the phenomena of mania, or profound mel-
ancholia, supervening upon these symptoms.
Sometimes an explosion of mania takes place
more or less suddenly ; but more frequently the
patient's manner becomes quick, the temper ir-
ritable, and the nights restless, for two or three
days before the attack. The form of the men-
tal disorder varies remarkably ; but the mani-
acal states are the most common. Next to
these are melancholia, and diversified forms of
monomania. During either of these disorders,
and in melancholia especially, suicide may be
attempted or committed. Mania may alternate
with melancholia, and this last with other va-
rieties of partial insanity. At first, and partic-
ularly in cases occurring soon after delivery,
the disorder is maniacal. Sometimes the pa-
tient evinces a childish disposition for harmless
mischief; is gay and joyous ; laughs, sings, and
talks loud and long, occasionally obscenely, and
is careless of the infant and of everything about
her. She is often, also, suspicious ; imagines
everything poisoned ; and is busy with some
idea, illusion, or some fancied object. In oth-
er cases, the maniacal excitement is much more
intense ; and the conversation and conduct
more violent. These states may pass into mel-
ancholia, but very rarely into dementia or fa-
tuity.

539. b. The physical symptoms are referrible
chiefly to the digestive organs, and to the ner-
vous system. The bowels are torpid, the secre-
tions and excretions impaired and morbid ; the
stools are unhealthy, and generally very dark
and offensive ; and, from inattention or obsti-
nacy, sometimes passed without regard to the
natural calls. The tongue is moist, white,
furred, or loaded ; and as the disease proceeds,
it sometimes becomes brownish, mucous sordes
accumulating on the teeth and lips. There is
little or no appetite, and rarely much thirst.
The pulse is frequent, small, w-eak, compressi-
ble ; and sometimes it is but little, or not at
all, accelerated, or it becomes less frequent as
the disease proceeds. The skin is relaxed and
moist, particularly about the neck, and gener-
ally cool, especially on the extremities. Tho
head is often hot, or is warmer than usual, but
the heat is not always permanent ; it frequent-
ly occurs at intervals, and is sometimes great-
est when the rest of the body is cool. Occa-
sionally the scalp is cool throughout. The gen-
eral heat of the body is rarely increased, unless
when the disease is coincident with the first
secretion of milk, or with inflammation of the
breasts, or unless when caused by the violent
exertions of the patient. Pain, sense of press-
ure, or tightness of the head, is often felt, with
uneasiness of the scalp, noises in the ears, and
sometimes throbbings of the temporal arteries.
There is little or no sleep. The face is gener-
ally pale, unless when the maniacal excitement
is great, and then it is often flushed or turgid.
The eyes are vivid or slightly red ; but both

630

INSANITY, PUERPERAL— Diagnosis.

they and the face are occasionally pale, although
the patient is most violent. The abdomen is
usually soft, cool, and free from pain on press-
ure, unless sometimes in the hypogastric and
iliac regions. The breasts are generally flaccid,
and the secretion of milk either impaired or ar-
rested ; but the milk, in some instances, is not
materially diminished, although it is generally
deficient in its healthy and nutritive properties.
The lochia are often deficient, but they are
sometimes abundant or offensive.

540. c. The insanity of females recently de-
livered commonly assumes the form now de-
scribed ; but its character varies remarkably :
in some cases, it nearly resembles sub-acute
pkrenitis, delirium supervening, as in the form
of the disorder described by Dr. J. Burns, in
which the symptoms of morbid vascular action
in the encephalon precede the mental disorder.
In other instances, the insanity verges in its
character tovi^ards low nervous fever ; it is then
generally preceded by watchfulness, fever, the
supine posture, heat of scalp, and injection of
the conjunctiva. Images or illusions super-
vene, the ideas become rapid, and the delirium,
passing into a muttering delirium, is soon con-
firmed. The pulse is quick, and the milk and
lochia are usually suspended. Enough has been
stated to show that, as regards puerperal in-
sanity, as well as many other maladies, the
marked lines of demarcation attempted to be
drawn by authors and nosologists do not exist
in nature ; but that there is a gradual approxi-
mation of character observed in this, to other
diseases of the nervous system — that the tran-
sition from puerperal insanity to phrenitis on
the one hand, and nervous fever on the other,
is often manifest ; cases occurring in practice
of an intermediate nature, and referrible to one
malady as much as to another.

541. C. Insanitij during or after Lactation —
Insania Lactantium — Mania Lactea, Sauvages —
is generally gradual in its approach ; or it is
preceded by symptoms premonitory of its oc-
currence. When, however, violent impressions
are made upon the mind, or the secretion of
the milk is suddenly disturbed, the disorder may
burst forth unexpectedly. Generally, howev-
er, a change of temper or disposition is remark-
ed for some time previously. The manner be-
comes hurried, sleep disturbed, the temper irri-
table, the countenance suspicious or distrust-
ful, and the patient voluble and negligent of her
infant. At length, sleeplessness, incoherence,
or violence of language and conduct, and delu-
sions, supervene. Occasionally, various hys-
terical and cataleptic symptoms are associated
with these ; and sometimes acts of violence,
or attempts at suicide, are perpetrated, even
before the nature of the malady is suspected by
her friends. The disease may occur at any pe-
riod of lactation ; but it is more frequent on
weaning, or very soon afterward, than at any
other time. The melancholic and monomani-
acal forms of insanity are oftener observed du-
ring this period, than violent mania : and when
the latter occurs, it is apt to pass into melan-
cholia, or to alternate with it. Insanity during
this and the preceding periods may present
some one or other of the complications noticed
above {(} 166, ct seq.).

542. ii. Diagnosis. — The diagnosis of puer-
peral insanity is sometimes difficult, especially

after delivery. Some modern writers have en
deavoured to point out diiferences, rather than
to describe the relations really subsisting be-
tween it and other diseases, especially phrenitis
and low riervous fever. But, as I have already
stated, the transition of the one into the other
is not infrequent, or the pathological condition
of these maladies are very nearly the same in
many cases. The absence of fever has been
considered as particularly characteristic of pu-
erperal insanity ; but fever accompanies a con-
siderable proportion of cases, especially those
commencing about the fourth or fifth day, when
the secretion of milk excites some degree of
febrile commotion in the system, and, at a later
period, when the lochia disappear. Still, it is
a rapidity of pulse, and an irregular determina-
tion of blood, with increase of heat about the
head, rather than fever, that are more com-
monly observed.

543. a. In phrenitis, the patient has headache,
vertigo, throbbing in the temples, a beating
noise in the ears, flushing of the face, injection
of the conjunctiva, intolerance of light and of
noise, heat of the scalp, rapid pulse, dry skin,
suppression or sudden diminution of the milk
and of the lochia, constipated bowels, and
scanty and high-coloured urine, before deli-
rium appears ; and very frequently these symp-
toms are ushered in with chills or rigours. In
proportion as these phenomena are manifested
before the mental disorder appears, the disease
may be viewed as possessing an inflammatory
character. Puerperal phrenitis, moreover, soon
passes into stupor, coma, subsultus of the ten-
dons, catchings in the limbs, and unconscious
evacuations, and often terminates unfavourably
as early as the third, fourth, or fifth day, and
rarely passes the eighth ; whereas puerperal
mania, even in the most febrile and unfavour-
able cases, generally is prolonged beyond this
period, unless very injudiciously treated. In
the former, the physical disease is manifest and
developed before the delirium appears, and is
evidently the cause of it ; in the latter, the men-
tal disorder is coetaneous with, or even pre-
vious to the physical disturbance.

544. h. When low nervous fever occurs after
delivery, or during lactation, it will hardly be
confounded with this disorder, as the febrile
commotion precedes mental disturbance for
several days ; muscular power is prostrated,
the patient preserving the supine posture, or
being incapable of continuing any other ; the
pupils are but little sensible to light ; the tongue
is tremulous ; the patient is sleepless, and com-
plains of confusion and giddiness, rather than
of pain of head ; and when delirium supervenes
it is of an incoherent and muttering kind, and
very rarely violent or attended by muscular ex-
ertion. The pulse is very quick and small ;
the bowels are readily moved ; and the lochia
or milk is suppressed. As the malady pro-
ceeds, coma, starlings of the tendons, pickings
of the bedclothes, unconscious evacuations, and
the usual phenomena of nervous exhaustion^
terminate life.

545. These maladies the discriminating phy-
sician will never confound with true puerperal
mania, and he will carefully distinguish such
cases as present an intermediate form between
either of them and the latter disorder. He will,
moreover, keep in recollection the circumstance

INSANITY, PUERPERAL— Causes.

631

of these diseases frequently leaving, as the
physical disorder subsides, more or less of men-
tal disturbance behind them, which may as-
sume the form of chronic mania, or melancho-
lia ; and the risk of this result will be great in
proportion to the evidence of a hereditary pre-
disposition to insanity, and to the nervous or
melancholic temperament of the patient.

546. c. The relation of puerperal insanity to de-
lirium tremens has not been adverted to by wri-
ters, although the connexion is obvious in many
instances, and of practical importance. I have
been called to several cases which, in their re-
mote causes and essential features, were in-
stances rather of delirium tremens occurring in
the puerperal state than true puerperal insani-
ty. In some cases, the tremor is hardly to be
observed, or is present only for a short time ;
and yet the affection presents the other char-
acters of that disorder, and has arisen chiefly
from the abuse of intoxicating liquors. Puer-
peral insanity, attended by tremor, usually ap-
pears soon after delivery, and is to be imputed
chiefly to the effect produced on the system,
already injured by excesses, by the shock of
parturition, by the consequent evacuations, and
by the abstraction of accustomed stimuli.

547. iii. Prognosis. — Opinions of the result
of puerperal insanity were either stated in too
favourable terms, or imperfectly ascertained
previously to the appearance of the works of
EsQciROL, H.ISLAM, BuREOws, and Gooch. M.
EsQuiROL states, that of 92 cases, 53 recovered
and 6 died, leaving 31, or 1 in 3, as incurable.
Of 85 cases, admitted at Bethlem, Dr. Haslam
observed 50 recover, and 35 incurable. Dr.
BuREovvs mentions 57 cases, of which 37 re-
covered, 28 within the first six months ; 10 died,
1 committed suicide, and 1 1 remained uncured.
Dr. Gooch observes, that these statements pre-
sent a prospect unnecessarily gloomy and dis-
couraging ; for, of the many patients about
whom he had been consulted, he knows only
two who are now, after many years, disorder-
ed in mind, and of them, one had already been
so before her marriage. It should, however,
be recollected that only the more obstinate and
severe cases are sent to asylums, and not un-
til medical treatment had been already employ-
ed : hence the more unfavourable results fur-
nished by EsQuiBOL, Haslam, and Burrows
Of those not sent to such institutions, a much
greater proportion than that assigned by these
writers recover under judicious management,
particularly of the non-febrile form of the mal-
ady, which is, fortunately, the most common.
Cases attended by much febrile action, more
especially those approaching cither to the char-
acter of phrenitis on the one hand, or to that
of nervous fever on the other, are attended by
more danger, and frequently either terminate
fatally, or in permanent insanity, particularly
if a hereditary predisposition to insanity exists.
Of the 10 cases which ended in death, out of 57,
recorded by Dr. Blerows, 7 occurred within
twelve days, 2 within seven weeks, and 1 after
four months. Two had active uterine disease,
and 2 others died in consequence of relapses.

548. The caM«c* have a considerable influence
on the result. Of the cases which I have seen
in the Queen's Lying-in Hospital, and to which
I have been called in private practice, a much
larger proportion of incurable and fatal cases

has existed among the unmarried than in the
married. Previous distress of mind is suflS-
cient to account for these results. Of the cases
of married females that have occurred in the
above institution since I became consulting
physician to it (1822), two were represented to
me by the matrons as having been caused by
remorse consequent upon incestuous inter-
course, and both these terminated fatally. It
may be inferred, from the results observed by
several practitioners, that about four patients
in five recover their intellects ; and that about
one in eight die, generally within the first month
of the disease, the greater number within a fort*
night. The proportion, however, of unfavour-
able cases is manifestly greater than this in
unmarried females. The chief danger in this
disease, especially in the more pure, or non-feb-
rile form of it, arises from debility and ex-
haustion of nervous power. And this is the
more to be dreaded when the disorder follows
hajmorrhage, or improper bleeding, when the
pulse is very rapid, weak, or small, or flutter-
ing ; and when there are great restlessness and
long-continued want of sleep. Recovery is
generally more likely to take place, the more
remote the attack from the period of parturi-
tion, or when the disorder occurs during lacta-
tion. The appearance of the disease during
pregnancy should lead the physician to antici-
pate a severe form of it after delivery. Moral
causes, also, give rise to more severe and dan-
gerous attacks than physical causes ; and the
maniacal form terminates favourably more fre-
quently, and in a shorter time, than the melan-
cholic, in as far as the recovery of reason is
concerned ; but deaths are more likely to oc-
cur in it, at least after a short period from the
attack. Of 55 recoveries, M. Esquirql states
that 38 took place within the first six months.
Of 35 recoveries, recorded by Dr. Burrows,
28 occurred within the same period. When the
delirium is of a gay character, and the patient
sings, laughs, talks wildly, and is a little mis-
chievous, it rarely lasts long ; but when it is
attended by great suspicion, apprehension of
poison, and sullenness, or when suicide »s med-
itated or attempted, it then assumes a more
serious character, and is not soon cured. Upon
the whole, this disorder requires a very cau-
tious and guarded prognosis.

549. iv. Causes. — A. The predisposing causes
of puerperal insanity are nearly the same as fa-
vour the occurrence of other forms of mental
disorder, the puerperal states being superadded
causes of predisposition to these, and the pe-
riod immediately following delivery being the
most influential of these states. Hereditary in-
fluence, constitutional debility, and susceptibil-
ity of the nervous system, most powerfully co-
operate with the puerperal states. Of the 92
cases noticed by Esquirol, 16 were attacked
from the first to the fourth day ; 21 from the
fourth to the fifteenth day ; 17 from the six-
teenth to the sixtieth day; 19 from the sixti-
eth to the twelfth month of lactation ; and 19
after forced or voluntary weaning. Dr. Bur-
rows remarks, that of the 57 cases which he
has observed, the disease commenced on or
before the fourteenth day in 33 ; and after the
fourteenth day, and before the twenty-eighth,
in 11 instances. As to the age at which the
disorder most frequently occurs, he observes,

682

INSANITY, PUERPERAL— Causes.

that from the agjB of twenty to thirty it is more
frequent than at any other age, in the propor-
tion of nearly t^vo to one. M. Esquirol states,
that of 92- females, 22 were from twenty to
twenty-five years of age ; 41 from twenty-five
to thirty; 16 from thirty to thirty-five; 11
"from thirty-five to forty ; and 2 from lorty to
forty-three. The comparalive frequency of this
disease in married and unmarried females has
not been duly attended to. Nearly one third
of the cases adduced by M. Esquirol were
those of unmarried women ; while a fourteenth
only of those observed by Dr. Burrows were
unmarried. There can be no doubt that the
disease is, relatively to the number of pregnant
single women, much more common in them
than in the married. This is to be imputed to
the more general and intense operation of the
moral exciting causes on the former than on
the latter. M. Esquirol imputes the frequency
of this malady in the unmarried, in great meas-
ure, to the influence of suppression of the lac-
teal secretion, and premature weaning, com-
paratively iev; unmarried females suckling their
children. In this country, however, the ma-
jority of them find situations as wet nurses.
Females who have been subject to hysteria, par-
ticularly its more severe and obstinate forms,
previously to pregnancy, are very liable to pu-
erperal mania ; and those who have been once
attacked are highly predisposed to the disease
on each successive return of the puerperal
states. Of the predisposition arising out of
hysteria, I have met with several remarkable
instances. Some writers have remarked, that
nearly one half of the cases which they have
treated have, more or less, depended upon he-
reditary predisposition. Of the instances which
I have seen in the lower classes, a large pro-
portion has occurred in those who had been ad-
dicted to the inordinate use of spirituous or
malt liquors.

550. B. The exciting causes are also very fre-
quently the same as produce mental disorders
in other circumstances ; although tliere are
others which especially belong to the puerperal
states, or which produce their effect chiefly in
these states. There are some, also, of a phys-
ical or pathological kind, consisting of changes
in the sexual organs and nervous system, con-
nected with impregnation, parturition, and lac-
tation. The most common exciting causes are.
moral emotions and errors of diet and regimen.
Of the latter, improper food, stimulating or
healing articles, exposure to cold air or cur-
rents of air, damp clothes, the evaporation of
liquid perfumes, the suppression of the lochia,
or of the milk, premature exertion, the use of
cold fluids, and neglect of the abdominal secre-
tions and excretions.

[Insanity also results Uomlaclation unduly ■pro-
tracted, especially where previous predisposition
to mental disease exists, and which hears close
resemblance to puerperal mania. The latter, as
is well known, occurs most commonly in women
of weakly, hysterical, and irritable habits ; and
in the same class, mania from over-lactation is
most frequently witnessed. Where it arises
I'rom protracted lactation, it commences by pe-
culiarity of sentiment or temper, and is plainly
evinced by pertinacious adherence to an opin-
ion once formed, however erroneous. If the
child is not taken from the breast, the pulse,

notwithstanding a more generous diet, becomes
quick and sharp, the skin parched, and the
whole system deranged. Drs. Laycock and
AsHWELL think that insanity from this cause
is rarely of a serious nature, except in cases
where generous diet and wine are injudicious-
ly administered. We are to seek for the pa-
thology of this functional result of undue suck-
ling in an impaired and attenuated condition
of the blood, and a consequently depressed
state of the nervous system, especially of the
organic system of nerves. Dr. Ashwell sup-
poses that any prolonged, undue lactation may
induce organic changes in the brain, lungs, and
uterus.* (" A Practical Treatise on the Diseases
peculiar to Women, &c , Am. ed., p. 514.)J

551. Moral emotions have a remarkable effect
upon both the nervous system and the secre-
tions during the puerperal states — great in pro-
portion to the nearness of their occurrence to
the period of delivery. The comparative influ-
ence of the moral causes has been attempted
to be estimated by M. Esquirol and Dr. Bur-
rows ; but the application of numbers to the
estimation of the separate value of individual
influences in the production of disease, espe-
cially as diversified combinations of both exci-
ting and predisposing causes generally occasion
it, leads rather to erroneous than to correct
conclusions, and is, at best, a parade of accu-
racy in respect of matters which admit only
of approximations to the truth. Besides, the
relative influence of particular causes vary with
the age, constitution, modes of living, previous
health, and occupations of the patient ; and
with seasons, weather, epidemic states of the
air ; and with climate, situation, and peculiar
circumstances of the country. M. Esquirol
states that 46 of 92 cases of puerperal insanity
were caused by moral emotions, while Dr. Bur-
rows estimates the physical as being ten times
more influential than the moral causes. My
observations lead me to infer that M. Esquirol
is very much nearer the truth, even allowing

* [Case of insanity resulting from undue suckling. — Mrs.
P., aged 28, of fair complexion, blue eyes, and light hair, at
the age of 17, suffered from clilorosis; but, under a course
of tonics and sea air, she recovered. In 12 months she again
relapsed, and again recovered under the same treatment. At
the age of 19 siie married, and before her 20th year she had
a living male child. She nursed this child for 12 months, and
was again confined soon after she had reached her 21st year.
Since this period she has borne four living children, and
has miscarried twice : she has nursed every child. Her
last infant was born eight weeks before I saw her. My at-
tendance was requested or account of her having been
weak, very desponding, and sharp in her manner. On vis-
iting her, I was struck with her pale, anxious countenance ;
the pupils were dilated ; the pulse was small, quick, and
irritable. She complained of great thirst, of a pain at the
top and back of her head ; and there was also excessive icu-
corrhoea. I obtained answers to my questions with some
difficulty, although, in general, she was exceedingly com-
municative. Tonics, change of air, &c., were ordered, and
the child was partially weaned and fed. The symptoms,
hovvever, became worse, and her conduct was exceedingly
violent. She attempted, more than once, to destroy both
husband and child. The latter was immediately removed,
her head was shaved, nutritious, but unstimulating diet was
ordered, together with tonics and sedatives. These meas-
ures were diligently prosecuted ; but at length it was thought
right to remove her to an asylum. Here sho continued four
months, and returned home entirely recovered. Ten m<mlh.s
subsequently she was again coiilined of a living child, and
within five months her insanity returned. After a fruitless
employment of remedies, she was again placed under re-
straint ; and having remained there five months, she was
sent home quite well. Twelve months from this period she
gave birth to another living infant, and, at the suggestion
of her medical attendant, slie did not attempt to nurse it,
and her intellect has continued unimpaired. — {hoc. cit.^'l

INSANITY, PUERPERAL— Pathology— Treatment.

633

hereditary predisposition, which exists in a very
large proportion of cases, to be a physical cause.
The most frequent moral emotions are those
which have been already noticed (^ 549) as op-
erating chiefly on the minds of the unmarried ;
also fright, fear, anxiety, chagrin, anger, do-
mestic dissensions, grief at the desertion of the
father, or at the death of the infant ; dread of
the malady after having experienced an attack,
&c. The influence of terror and fear was
shown by the cases which came under the care
of M. EsQuiROL in 1814 and 1815. Of 13 which
he admitted in the former year, 1 1 were caused
by fear. A sudden shock, or whatever startles
or alarms the patient, as a sudden clap of thun-
der, will often occasion the disease, especially
soon after parturition. The abuse of intoxica-
ting liquors exerts both an exciting and a pre-
disposing influence, and it has not only a direct,
but also an indirect effect. These liquors ei-
ther excite the malady by immediately stimu-
lating the nervous and vascular systems, at pe-
riods when susceptibility is augmented and vi-
tal power impaired, or, in other cases, they in-
directly cause it, by the sudden abstraction of
the accustomed excitement they have afforded,
at a time when the frame is depressed by the
suflering and by the evacuations attending par-
turition. When puerperal insanity proceeds
from this source, it may either assume more or
less of tike characters of delirium tremens {<)
546), or vary but little from its usual forms.' In
order that the treatment should be successful,
care ought to be taken to ascertain the exist-
ence or non-existence of this cause from the
attendants most competent to furnish the infor-
mation.

552. V. Pathological States. — A. The ap-
pearances observed aflcr death, caused by pure or
true puerperal insanity, particularly when it oc-
curs soon after delivery, or during suckling, con-
sist chiefly of deficiency of blood in the brain
and its membranes, and, in some instances, of
slight effusions of serum between the mem-
branes and in the ventricles. There are no
signs of inflammation, or even of congestion,
excepting in such cases as have approached in
their characters to phrenitis on the one hand,
or to nervous fever on the other ; and in these,
appearances of an inflammatory or of a congest-
ive nature, with or without efTusions of serum,
are often observed. The pure cases of the
malady present little besides ansmia of the brain
and its membranes, and of the system general-
ly. Morbid changes in other parts of the body,
or even in the sexual organs, are coincidences
or accidents only.

553. B. The morbid condition more immediately
occasioning the malady seems to consist of in-
creased nervous susceptibility and greatly im-
paired power, frequently associated with defi-
ciency of blood. The balance of the circula-
tion is also often disturbed, and irregular de-
terminations of it take place, especially to the
brain and to the uterus. While the circulation
is more active in one (juarter, it is deficient in
others, and the functions of the brain are thus
directly or sympathetically disordered. After
impregnation, the organic nervous influence of
the uterus and ovaria is more or less develop-
ed and exalted, and the excitement of these or-
gans often extends to, or reacts upon, the cer-
ebro-spinal nervous system and its manifesta-

tions, exciting and disordering it and its func-
tions. After delivery, the susceptibility of the
brain, and of the nervous systei^ generally, iar
increased, and the disposition of these to be
sympathetically afTected by the states of the
mammae, uterus, and ovaria proportionately .
augmented, the susceptibility being great in
proportion to the shock which the system has
sustained from the parturient process, and to
the loss of blood and exhaustion. The occur-
rence of the disease during lactation is to be
imputed chiefly to exhaustion, debility, and vas-
cular inanition, and its appearance after wean-
ing, to a disturbance of the balance of the cir-
culation, a greater determination of blood ta-
king place to the brain than to other parts, upon
the cessation of the secretion of milk, as well
as upon the premature cessation of the lochia.

554. vi. Treatment. — A. Insanity occurring
during -pregnancy is generally either partial, or
of short duration when it assumes a maniacal
form. In either case, the treatment should
chiefly depend upon the state of the vascular
system as to fulness, action, and tone. When
the circulation is deficient in none of these con-
ditions, and particularly when plethora exists,
a small blood-letting will then be useful ; but in
doubtful, or other circumstances, cold applied
to the head, warm and stimulating pediluvia,
refrigerants, and refrigerating diaphoretics,
cooling aperients, and antispasmodics, con-
joined with narcotics, as hereafter prescri-
bed, must constitute our principal means of
cure, aided, however, by judicious moral man-
agement, and by appropriate diet and regimen.

555. B. Insanity occurring soon after parturi-
tion requires the utmost discrimination in as-
certaining, 1st, the presence of the disease in
its pure or unmixed character ; 2dly, those
mixed states which partake either of the char-
acter of phrenitis, or of that of low nervous fe-
ver, and the greatest care in the selection of
remedial agents. In this disease it is always
most important to consider the state of the vas-
cular system, in connexion with nervous ex-
citement, and to inquire as to the dependance
of whatever degree of vascular action that may
he present upon the condition of the nervous
system, and upon the mental disorder and mus-
cular efforts. In all cases, moreover, it should
never be overlooked that the frame has receiv-
ed a shock during the parturient process, that
the nervous system has endured great excite-
ment and suffering, and that the vascular sys-
tem has sustained a loss, sufficient, in many
cases, seriously to disturb the healthy relation
subsisting between the state of the vessels and
their contents, and to disorder the balance of
the circulation in different parts of the body.
These considerations will generally guide the
practitioner in the treatment of the more diffi-
cult, doubtful, or mixed cases : the more sim-
ple and pure instances of the disease will pre-
sent neither difficulty nor doubt.

556. a. Blood-letting in any mode is most in-
jurious in puerperal mania and melancholia, and
in such cases as are attended by fever, or where
the symptoms approach those of delirium tre-
mens. Indeed, puerperal insanity, occurring in
the lower classes of^ society, not unfrequently
is very closely allied to that disorder, owing to
the circumstances already noticed {^ 546,551).
In those cases which assume the form of ner-

634

INSANITY, PUERPERAL— Treatment.

vmis fever vascular depletion is also pernicious.
Where, however, the malady approaches, in
some of its features, a ■phrenitic form — when
the head is hot, the face flushed, the pulse hard
or strong, and the secretions suppressed — the
propriety of blood-letting might seem to be ob-
vious ; yet even in these cases the practice, al-
though cautiously resorted to, might be injuri-
ous, or fail of proving beneficial. Those symp-
toms are sometimes fallacious, for they are oc-
casionally produced by the violence of the ner-
vous and mental excitement, or of the physical
exertion, relatively to the power of the system,
and are of short duration, dangerous exhaus-
tion soon supervening. In such instances, even
a small blood-letting would only hasten and in-
crease the consequent depression. In cases
which commence with headache, fever, flushing
of the face and eyes, diminished secretion and
excretion, and occasionally preceded by chills
or rigours, and in which the mental disorder is
clearly consequent upon the inflammatory and
febrile symptoms, a recourse to blood-letting,
and to other antiphlogistic means, is obviously
requisite, for the disease is more or less in-
flammatory, or consists of a state of active con-
gestion approaching inflammation. Yet, even
in these cases, the practitioner will be guided,
in some measure, by the rapidity with which
the mental disorder followed the physical dis-
turbance, by the previous condition as well as
the existing circumstances of the patient, by
the evacuations attending and consequent
upon parturition, and by the several phenom-
ena characterizing the case. Whenever the
mental affection follows quickly upon the cere-
bral and constitutional symptoms, vascular de-
pletions of any kind are seldom of service, un-
less very prudently prescribed.

557. When there are much heat of the scalp,
flushing of the face, beating of the carotid ar-
teries, and no indication of urgent debility or
exhaustion, the previous condition and evacu-
ations of the patient furnishing no sufficient
reason for the existence of these states, then
may leeches be applied behind the ears, or
around the occipit, and cold to the head, with
great advantage. While ice, cold lotions, &c.,
are placed around the shaved head, the feet and
legs should be frequently bathed in warm water,
to which mustard or scraped horse-radish has
been added. In the majority of cases, where
inflammation is dreaded after delivery, there is
only active determination of blood to the head,
the circulation in the extremities and in other
parts being impaired ; and in these the contin-
ued application of cold to the head, and the fre-
quent or persevering use of derivatives to re-
mote parts, or to such as experience an insuf-
ficient supply of blood, will generally remove
the disorder. The application of blisters to the
nape of the neck has been advised by many, but
they are seldom of much service in the mania-
cal states of disorder. In the melancholic form,
or when there is a tendency to stupor, rather
than to high excitement, blisters on the nape,
or behind the ears, are generally of use.

558. b. In a great proportion of cases of pu-
erperal insanity, fsecal accumulations have form-
ed in the alimentary canal, and morbid secre-
tions have collected in the gall-bladder, hepatic
ducts, in the csecum, and in the cells of the co-
lon. The existence of these collections is in-

dicated by a loaded, foul, or furred tongue, by
a foetid breath, by a lurid or discoloured state
of the skin and of the complexion, by more or
less fulness in the regions of the caecum and
sigmoid flexure, and by dark and offensive evac-
uations. The propriety of purgatives in all such
cases, and of emetics in many of them, is un-
doubted. The latter, however, should not be
used when debility or exhaustion is extreme —
when the face is pale, the skin cold, and the
pulse very quick and weak. Ipecacuanha is
the best emetic in ordinary circumstances, but
when vital depression is considerable, any of
the warmer emetics prescribed in the Appendix
(F. 402, 403) may be used. After its operation,
calomel may be given with camphor and some
cathartic extract, and a few hours subsequent-
ly, a draught, with rhubarb and magnesia, or
any other purgative, may be taken. The full
operation of these upon the bowels should be
secured either by their repetition or by the ad-
ministration of enemata, and especially of those
containing castor oil and spirits of turpentine.
In most cases, the stomachic aperient, consist-
ing chiefly of the compound infusions of gentian
and senna (F. 266), or the compound aloetic
pill or decoction, will be the most appropriate
medicines.

559. c. Having evacuated morbid secretions
and faecal collections, it is next requisite to
support the constitutional powers and allay ner-
vous excitement by antispasmodics or diffusive
stimulants, conjoined with narcotics or sedatives.
Where debility, exhaustion, or vascular inani-
tion is urgent, it will generally be necessary ei-
ther to combine restoratives or stimulants with
alvine evacuants, where the latter are requi-
site, or to give the former in the intervals be-
tween their exhibition. Narcotics are more ben-
eficial in puerperal than in any other form of
insanity, particularly when conjoined with cam-
phor, ammonia, or aromatics. Since 1815, I
have usually prescribed five grains of the ex-
tract of hyoscyamus, with an equal quantity of
camphor, in the morning and afternoon, and
double thisquantity of each at bedtime. Where
there are much heat of the head, flushing of
the face, and thirst, these symptoms should be
removed by cold applications, purgatives, re-
frigerants, and external derivatives, before cam-
phor or ammonia is exhibited ; but, notwith-
standing their presence in a moderate degree,
tlie camphor and hyoscyamus may be exhibited,
provided that these means are persisted in, and
the enemata already advised are occasionally
administered. In still more urgent cases, the
camphor may be given more frequently, con-
joined either with hyoscyamus, or with opium
or morphia, a larger dose being given shortly
before bedtime. I have rarely found the fol-
lowing draught to fail in giving repose, and in
contributing to the clearing up of the mind sub-
sequently, when prescribed after the requisite
alvine evacuations, and when the head is kept
cool, and the lower extremities warm : the en-
ema has also proved very generally of service.

No. 277. R Morphiae Acetatis pr. J; Liquoris Ammonia
Acetatis Jjss. ; Mist. Camphorae fj. ; Acidi Acetici TUvj. ;
Spiritfls Lavand. Comp., Spir. MyristicE, Spir. Rosniarini,
aa 3SS. ; Sirupi Papaveris 3j. M. Fiat Haustus, horft som-
ni sumendus.

No. 278. ft Camphorae rasse gr. x. ; Asaf<rtidie 3ss. — 3j. ;
Extr. Rutee 3ss. ; tere cum Olei Terebinthiiiip Jj. ; Olei
Ricini jj. (vel Olei Olivie Jiij.) ; Decocti Aveuae f x. ad

INSANITY, PUERPERAL -Treatment.

635

Jxiv. ; Sirupi Papaveris Jij. ad Jss. Fiat Enoma, pro re
natft injicienduin.

560. d. It is important to administer due sup-
port to the system during the treatment of the dis-
ease, more especially when there is neitlier a
febrile state of the pulse, nor heat of the head
or surface ; and this support, whether medici-
nal or dietettcal, should have due reference to
the previous modes of living and habits of the
patient. When puerperal insanity becomes
chronic, or when it appears in the course of
suckling, and particularly when there is a total
absence of inflammatory or febrile symptoms,
tonics, especially the infusion or decoction of
cinchona, or any of the bitter infusio7is, may then
be given with ammonia and aromatics, the se-
cretions and excretions being promoted by the
usual means; change of air and of scene, and
appropriate moral treatment, being brought in
aid of the physical remedies. When the pa-
tient has been addicted to the use of intoxica-
ting liquors, and especially if the disease as-
sume a form approaching to delirium tremens,
then opium, with camphor or with ammonia,
should be freely administered. Brandy or wine
may be given in arrow-xoot ; or even tvarm,
spiced, or mulled u-ine, or ale may be occasional-
ly allowed.

561. e. The diet requires much attention. Drs.
PRicH.tRD and GoocH remark, that patients in-
cur some risk of being starved in this disease,
through the mistaken notions of their attend-
ants, who are apt to consider the excitement of
the malady a reason for withholding food ;
when this very state, owing to the exhaustion
often produced by it, renders due support es-
pecially necessary. Farinaceous fluids of a
nutritive quality, as rice, arrow-root, sago, &c.,
should be given at short intervals, when febrile
symptoms preclude the use of animal food.
Warm milk, or broth, may also be allowed, but
should be taken in small quantity at one time.
In protracted cases, solid meat, malt liquor,
wine and water, bottled porter, or the bitter
ale usually sent to India, will often be of ser-
vice. Patients who have been accustomed to
live fully, and to the use of stimulating liquors,
must be allowed such food and beverages as
their physical symptoms will permit, without
reference to the state of the mental disorder.
When suckling is concerned in producing,
heightening, or perpetuating the mental affec-
tion, by draining an already weakened consti-
tution, a nurse must be procured, and a nu-
tritious and tonic diet and regimen prescribed,
with change of air, and the use of chalybeate
waters.

562. C. When insanity appears during suck-
ling, the treatment is nearly the same as that
just described ; a nutritious and cordial diet
should be immediately allowed, and meat ta-
ken daily, with about four ounces of wine.
Purging in such cases is injurious, but the bow-
els should be kept in a regular state by the
compound decoction of aloes, or by the infu-
sions of gentian and senna. If the mental dis-
ease occur after sudden weaning, and particu-
larly if it assume a maniacal form, and if there
be any reason to infer that an inflammatory af-
fection of the brain has supervened upon the
sudden suppression of the milk — if the symp-*
toms already mentioned, as indicating this
state, appear, then appropriate means should be

prescribed ; but this is not to be determined,
nor is the treatment to be regulated by the
disorder of the mind, but by the bodily symp-
toms.

563. When the milk becomes scanty, or
ceases to be secreted, and the mental disorder
seems to be aggravated by this circumstance,
or has supervened upon it, the secretion should
be encouraged by keeping the child to the
breast. If the lochia disappear prematurely,
means should be taken to procure its return.
For this purpose, the warm bath, the semicu-
pium, or the hip bath, may be used ; and, if
these fail, leeches may be applied on the in-
sides of the thighs, near to the groins, and the
hip bath be subsequently employed. Warm
fomentations may also be applied to the pu-
denda, or over the pubes. At the same time,
cold applications around the shaved scalp ought
to be assiduously employed.

564. The constant attendants on the patient
should control her mildly, but effectually ; not
irritate her, but protect her from self injury :
servants, or monthly nurses, can seldom do
this ; they ought, therefore, to be removed, and
a nurse accustomed to the care of deranged fe-
males placed in their stead. The patient should
never be left alone, and everything with which
self-injury can be effected should be carefully
removed ; the windows ought also to be se-
cured. The husband or near relations ought
never to be left alone with the patient, but
should be excluded until the state of the disor-
der permits their admission. It is generally
necessary to remove all persons who are sour-
ces of excitement of any kind. Seclusion, ia
some mode or other — partial or complete — is
generally necessary ; at least, for some time.
There is often, however, great difficulty in car-
rying this into effect in such a way as will tend
to the comfort and speedy recovery of the pa-
tient. Removal to an asylum is not so fre-
quently requisite for the mental disorders of
puerperal patients as for insanity occurring in
other circumstances. It is principally required
in the more obstinate and prolonged cases, and
after other measures of partial or complete se-
clusion have been tried. Dr. Gooch remarks,
that, where seclusion has been adopted, there
may come a time at which some interruption
to this solitary life may be advisable. When
the disease has lasted long, when the patient
expresses a strong wish to see some near friend,
when she entertains illusions which the sight
of some one may efface, the admission of such
person should be tried. It is well observed by
Dr. Haslam {Moral Management of the Insane,
p. 14), that confinement is too indiscriminately
recommended and persisted in. An intercourse
with the world has dispelled, in many instan-
ces, those hallucinations which a protracted
seclusion, in all probability, would have added
to and confirmed. In its passive state, insani-
ty has been often known to wear off by per-
mitting the patient to enjoy her liberty, and to
return to her usual occupations and habits.
There is obviously a period of the malady ap-
proaching convalescence, in which the bodily
disease is loosening its hold over the mental
faculties, and in which the latter are capable of
being drawn out of the former by judicious ap-
peals to the mind, and by a salutary moral
management.

636

INSANITY, SUICIDAL— Occasions op.

[Out of 511 cases of insanity admitted at the
Bloomingdale Asylum from physical causes, 43
cases followed parturition, and assumed the
different forms of mania, monomania, melan-
cholia, and dementia ; two cases occurred du-
ring pregnancy ; four during lactation ; 20 ca-
ses originated in functional and organic disease
of tlie uterus ; eight were attributed to the final
cessation of the menses : making a total of 77
instances of mental derangement dependant on
the peculiarities of the female system. — (Mac-
DONALD.) M. EsQuiROL states that there were 92
cases of puerperal madness out of 1119 insane
females admitted during four years at Salpe-
triere ; he found the proportion, however, far
greater in the higher classes of society, being
as high as 21 out of 144. Dr. Haslam enu-
merates 84 cases of puerperal mania in 1644
cases admitted at Bethlem ; and Dr. Rush reck-
ons five such cases in 70 received into the hos-
pital for lunatics in Philadelphia.]
XI. Suicidal Insanity. Syn. — Suicide — Self-

H0.MICIDE ; Smctdium, Autochiria; Melancholia

Suicidium ; Selbslmord, Germ. ; Le Suicide,

Fr. ; Suicidio, Suicida, Ital.

565. Under suicidal insanity, I proceed to con-
sider self-destruction or self-homicide, whether it
be scrtoushj entertained, or attempted, or perpe-
trated.

566. The religion, the laws, and the man-
ners of a people contribute in a remarkable de-
gree to the opinions entertained respecting sui-
cide, and to the frequency of it among them.
Of the influence of the laws on self-destruc-
tion, sufficient proofs have been furnished in
recent times ; and the restraints formerly im-
posed by them upon minds insufficiently in-
fluenced by rational views of religion, being
now, in a great measure, removed, this crime
has become much more common, and has as-
sumed an importance equally great, in a moral
and social, as in a strictly medical point of view.

567. The ancients, in general, condemned
suicide, unless on occasions calculated to ben-
efit the common weal. Several stoical writers,
however, attempted to justify it by reasoning
and by their examples, while the opinions of
others respecting it were either contradictory
or insufficiently expressed. Legislation regard-
ing it was formerly, and still remains, very dif-
ferent in different countries, it being in some
places allowed by the laws, in others tolerated
only in certain circumstances, and in some con-
demned as a crime, The Christian religion, of
whatever sect, and the doctrines of the Koran,
regard it among the greatest of sins ; while it
is permitted, or even encouraged, by numerous
pagan rites. At the present day, the opinion,*
by no means generally received, although very
commonly acted upon in this country, that sui-
cide IS always an insane act, leaves every mem-
ber of the community at liberty, without any
degrading penalty attached to the act, to dis-
pose of his own life as he pleases, without
reference to the claims of those depending
upon him, or of society in general. The knowl-
edge that no indignity will result to his body,
and no discredit to his memory, thus becomes
an incentive to self-destruction ; and, even

* In respect of suicide, opinion is as strong as a legislative
enactment, inasmuch as it determines the coroner's jury as
to their verdict— this act being always found by them as
that of insanity.

when it is not an incentive, it cannot, at least,
impose any restraint upon an impulse to com-
mit this act when a weak-minded person is sub-
jected to chagrin, passion, and misery.

568. That suicide is frequently, or even gen-
erally, caused by some one or other of the nu-
merous forms of insanity, may be admitted ;
but that it is thus occasioned in all cases, is
not so manifest. It may be said that it is an
act of moral insanity ; and, as far as immorality
and passion may be viewed as temporary in-
sanity, so far may it be considered as such.
But that it alone constitutes insanity, or that,
in a considerable proportion of the cases of it,
especially those wherein mental sanity has
been disputed, the mind is disordered even to
the extent contended for, in respect to the
forms of moral and partial insanity described
above, is not so evident. That the mind is im-
paired, and the judgment so far weakened as to
be swayed by morbid feelings and impulses, or
to be unable to withstand the suggestions of
passion and chagrin, may be allowed ; and, as
far as a weakness of mind, permitting the im-
pulsions of passion their full career, may be
considered as insanity, so far may suicide be
viewed in this light. We observe the mind of
the petted and spoiled child to have the weak-
ness and susceptibility natural to the early sta-
ges of its development increased by the indul-
gence, and remark the effects produced upon
it when a desired object is withheld. In like
manner, the adult mind, unexercised and im-
perfectly strengthened by opposition and dis-
appointments, and pampered by enjoyment and
success, experiences a sudden revulsion upon
unexpected reverses or indignities, is thereby
irritated as well as depressed, and accuses it-
self or Providence, the impulses excited by
these feelings being sometimes carried into ef-
fect before the sober dictates of reason can
withstand them, or these impulses more or less
quickly overthrow the efforts which reason may
make. In most cases, these efforts are too
feeble to counteract the impulses arising out of
outraged feelings, or to subdue the sufferings
of wounded self-love, or the stings of injured
honour. The mind, already weakened by indul-
gence, is the easier overwhelmed by these
emotions, the more intensely feels the shock,
more quickly sinks before it, and is the less
capable of making an effort to recover itself,
the less it is swayed by the dictates of religion
and principle, and the less it is deterred by
fears of any indignity, or of the reprobation of
opinion. All these sentiments come in aid of
the mind in adversity, or during contrarieties,
when duly regulated, although weakened, and
conduce to a healthy moral reaction ; but they
can have no influence where they have never
been habitually entertained.

569. i. Occasions of Suicide. — A. The exci-
ting causes, or the circumstances determining self-
destruction, are very diversified. Whatever may
be the motives or incentives to this act, they
promise to the imagination something prefera-
ble to life, or a lesser evil than existence : 1st.
Suicide may be committed in circumstances,
or with motives calculated to excite admira-
tion, or, at least, to preclude the imputation of
blame ; but such occasions are rare ; and al-
though not infrequently recorded in ancient
history, they rarely or never occur in modern

INSANITY, SUICIDAL— Occasions of.

637

times, or in the present state of society. 2dly.
Suicide is often caused, in some countries, by
religious rites or institutions, by received no-
tions respecting injured honour, and by hopes
of thereby passing into a happier state of ex-
istence. 3dly. It is very frequently occasioned,
in barbarous communities, by a species of nos-
talgia, by forcible removal from home, or by
slavery, and by ill usage, in connexion with a
belief of thereby returning to former abodes in
another state of existence. 4thly. It occurs
very frequently during delirium and mania, in
consequence generally of some illusion, false
perception, or error of judgment. 5thly. Du-
ring melancholia it is very commonly attempt-
ed, and the idea of committing it is generally
entertained long before it is perpetrated. 6thly.
It is sometimes, also, attempted in almost all
the other forms of partial insanity, and particu-
larly those attended by depression and anxiety
respecting a state of future existence, or by
unsettled views of religion. 7thly. Suicide oft-
en is suggested by the emotions consequent
upon reverses, wounded self-love, chagrin, and
contrarieties of all kinds, and by the violence
or intensity of passion and anger : the enraged
feelings, being incapable or unable to exhaust
themselves upon the object which excited
them, recoil upon themselves, and often thus
originate a suicidal impulse, which is not al-
ways successfully resisted. 8thly. A suicidal
suggestion may arise from various circumstan-
ces of a negative or passive kind, from satiety,
from ennui, from the want of excitement, from
the excess of gratification, and the exhaustion
of all its sources, &c. In such circumstances,
the idea may long be entertained, and, ulti-
mately, either carried into effect or laid aside
from a change in the mental or physical state
of the individual. 9thly. It may proceed from
a mental infection or sympathy — from the de-
tails contained in the public caterers to the
gratification of the more debased of our moral
sentiments, of various modes or instances of
self-destruction — and from a desire, during
states of chagrin or disappointment, of obtain-
ing notoriety by the manner of carrying it into
effect. lOthly. It is often committed in order
to avoid public exposure and ignominy, or pun-
ishment of a severe or lasting kind, llthly.
It is more rarely had recourse to in order to es-
cape from violent pain, or the various miseries
attending want and destitution, and from feel-
ings of despair. r2thly. From remorse or self-
reproach. 13thly. From a morbid or insane
impulse, without any other obvious mental dis-
order. 14thly. From a species of fascination,
as when looking down from great heights.
ISthly. By weak minds in a state of irritation
and chagrin, in order to injure the feelings,
to occasion regrets, and thereby to revenge
slights or contrarieties on those who caused
them. 16thly. Suicide may be mutual and re-
ciprocal, caused by the same feelings, and by
the same or different means. 17thly. It may
follow murder. ISthly. It may be simulated.
Certain of these require farther remark.

570. a. The instances of self-destruction or
of self-devotion caused by patriotism, or by a
wish to benefit the community, or to escape
dishonour, have been generally viewed as pre-
cluding blame, and as hardly deserving to be
ranked as suicidal. The cases of Codbus, of

Decius Mijs, of CuRTius, of Otho, of the citi-
zens of Calais and of Rouen, may be referred
to as being of this kind. Zend and his follow-
ers inculcated that a wise man should be ever
ready to die for his country or his friends ; and
the Stoics, in general, taught that suicide was
preferable, not only to dishonour of any kind,
but even to the enduring of severe pain or lin-
gering disease. Among the Greeks and Ro-
mans, self-destruction was preferred by many
to subjection to a victor, or to a state of sla-
very. IsocRATEs, Demosthenes, Brutus, and
Cato terminated their own lives, rather than
fall into the hands of conquerors.

571. Theo-tena and the virgins of Macedon
committed suicide to escape dishonour ; and
numerous instances of a similar kind have oc-
curred in ancient and modern times. Lucretia
would not survive the dishonour she could not
prevent. Lvcurgus and Ciiarondas sacrificed
their lives in order to maintain the inviolability
of their own laws and institutions. Most of the
above instances of suicide may be viewed as
precluding blame, and some of them may claim
our admiration. But other instances, commit-
ted on less laudable occasions, have been con-
sidered as excusable by Montaigne, Dr. Donne,
Rousseau, Hume, and others. When Josephus,
who commanded the Jewish army, wished to
surrender to Vespasian, from a conviction of
the hopelessness of resistance, his soldiers in-
sisted upon their having recourse to suicide,
rather than to yield to a conqueror. But he
resisted their importunities, and concluded his
arguments by observing that " self-murder is a
crime most remote from the nature of all ani-
mals, and an instance of impiety against God,
our Creator."

572. b. The victims of religious rites, as in
India, and in the Canaries in former ages — of
national customs and manners, as in the Isle
of Ceos, Japan, &:c. ; and of ignorance ; and
of those persuasions which constitute a part
of religious belief, also — are not to be viewed
as instances of suicidal insanity, but as proofs
of the influence of high moral and religious con-
siderations and expectations, of the tyranny of
custom, and of false notions of honour ; and
they result legitimately from the training or
education of the mind from an early period of
its development. They are altogether different
from the suicides which were so frequent du-
ring the decline of Roman greatness, and which
proceeded chiefly from vice and licentiousness,
or, rather, from the sentiments and impulses
which are generated from these sources — sour-
ces so productive of suicide in some countries
at the present time.

573. c. Suicide in states oi mania, or oi delir-
ium, occur either from some involuntary or
blind impulse, or from some delusion, halluci-
nation, or false perception — as when a person,
in either of these states, throws up the window
of his room, and walks out of it, in the persua-
sion of his going out at the door. Maniacs, also,
attempt to destroy themselves at the com-
mencement of the malady, under the influence
of the moral despair which caused it ; and oth-
ers commit the act from the distress caused by
a knowledge that the disease is approaching or
is returning. A patient for whom I was con-
sulted during an attack of mania, from which
he recovered, experienced, after a time, similar

638

INSANITY, SUICIDAL— OccAsioHs op.

symptoms to those which ushered in the for*
mer attack. His friends were directed to take
the necessary precautions regarding him ; but
these he eluded, and committed suicide. This
act is occasionally, also, attempted during con-
valescence from mania, in consequence of re-
flecting upon the excesses committed during
the attack. It may even be accidental, owing
to attempts at escaping from restraint or se-
clusion.

574. d. In TKelancholia and monomania, suicide
is occasioned by illusions, or by the violence or
intensity of some passion or sentiment, or by a
sudden impulse which reason is incapable of
restraining, or which induces the act before
reason can be exerted, as more fully explained
above (ij 91, 92). In some cases, the morbid
impulse is partially or fully carried into effect ;
and, either in consequence of the nature of the
means of self-destruction employed, or of rea-
son having at last come to the rescue, attempts
are made by the individual himself to counter-
act them, these attempts either succeeding or
not, according to circumstances. The suicidal
impulse is occasionally developed in an early
stage of congestion of, or of inflammatory de-
termination of blood to, the brain; and either
previously to, or contemporaneously with, such
impulse, insane delusions or acts may be man-
ifested. If, in such cases, the means of de-
struction shall have the effect of removing the
morbid physical condition before extinguishing
life, the patient will make efforts at self-pres-
ervation. This is not infrequently the case
when suicide is attempted by dividing the ves-
sels in the neck. When self-murder is resort-
ed to during melancholia, from a fear of be-
coming insane, and with the feeling that it is
the patient's fate or destiny to commit it, the
conviction is sooner or later completely verifi-
ed. Indeed, when it is contemplated or at-
tempted in any form of partial insanity, the in-
tention is generally persevered in, although it
may be variously concealed, until it is accom-
plished in one way or another.

575. In melancholia, and other states of par-
tial insanity, or even previously to any symp-
tom of insanity being sufficiently prominent to
attract notice, or in consequence of some men-
tal shock or perturbation, the patient may con-
ceive that an internal voice calls upon him to
commit suicide, and may act in conformity with
it ; or he may entertain the idea long afterward,
either without being able to divest his mind of
it, or resisting the impulse to perpetrate it with
the greatest difficulty, and with the utmost ex-
ercise of his reason. A lady consulted me on
account of headache, during which she could
not look upon a knife without experiencing a
strong desire to use it against her own life ;
but her reason had always resisted the impulse,
which disappeared after treatment. In such
cases, if medical and moral means be not ap-
propriately employed, and often notwithstand-
ing the aid of both, the morbid impulse is ulti-
mately carried into effect. Among persons
who have been but little accustomed to self-
control, or to listen to the dictates of moral and
religious principles, such impulses are often
soon acted upon. M. Esquirol furnishes sev-
eral instances. A monomaniac, he states, heard
a voice within him say, " Kill thyself! kill thy-
self!" and he immediately obeyed the injunc-

tion. This writer remarks, that he has nevei"
known an instance of suicide from an irresist-
ible impulse without some secret grievances,
real or imaginary, serving as motives to the su-
icidal propensity. There are few states oi far-
Hal insanity that may not be attended or follow-
ed by this propensity. Of the delusions which
characterize melancholia, there are none more
productive of self-destruction, as Dr. DARwm
has remarked, than the fear of future damna-
tion and of present poverty.

576. e. Suicide may be committed under the
influence of passion, of violent anger, or of self-
accusation or remorse. When intensely excited
by anger, the mind, for the time, is in a state
truly maniacal ; and acts of violence to others,
or to the person himself, may be committed in
the height of the paroxysm, according to the
nature of the circumstance or occurrence caus-
ing the excitement. Suicide from this cause
is most likely to be the fate of those who have
not been sufficiently taught to curb their feel-
ings, and who have been improperly indulged in
early life, as Childe Harold describes himself;

" My brain became.
In its own eddy boiling, and o'envrought,
A whirling gulf of phantasy and flame ;
And thus, untaught in youth my heart to tame,
My springs of life were poisoned."

Remorse and self-reproach frequently lead to
self-destruction, as the only mode of escaping
from the enduring agonies they occasion. The
passions which " madden to crime" are often
followed by the most anguishing feelings of
self-accusation, which not infrequently arm the
hand of the sufferer against his own existence.
Shakspeare has powerfully and naturally illus-
trated this state of mind in his delineation of
the character of Othello. The victim of re-
morse is often haunted by dreams, from which
he awakens in a stateofphrensy, or of delirium,
in which attempts at suicide are sometimes
fully carried into effect ; and in his waking
hours, his mind is haunted by recollections
which become his domestic furies, and lash
him on to madness, " Sua quemque fraus,"
says Cicero, " et suus terror maxime vexat ;
suum quemque scelus agitat, amentiaque afficit ;
sua? malae cogitationcs conscientiiaeque animi
terrent. Ha? sunt impiis assiduaj domesticaeque
Furiae." But, while remorse thus leads to su-
icide, by at first more or less obviously disor-
dering the mind, this act as frequently is the
proximate result of the moral sentiment ; the
attempt, or the commission of it, being prece-
ded by no other morbid manifestation of mind
than the moral torture proceeding from the con-
sciousness of having committed a crime, great
either in itself or in relation to the various cir-
cumstances connected with it.

577. /. Reverses, mortified pride, impatience
under misfortune, and disappointments, are fre-
quent causes of suicide, especially in commer-
cial countries, and under free governments,
where there is a constant straining, among the
more educated classes, after wealth, honour,
and other direct or indirect means of power.
Many of the ancient, as well as modern instan-
ces of self-murder, are to be attributed as much
to the effects of reverses and mortified pride
upon the mind as to the higher motives to which
this act has been referred. The suicides of
Brutus, Antony, and Cleopatra, and of Pe-

INSANITY, SUICIDAL— Occii SIGNS of.

ess

TRONitJs and SAnoAVAPALus, may be viewed in
this light. Instances of self-destruction from
mortified pride, consequent upon the failure of
attempts at becoming conspicuous at public
meetings, in the senate, or at the bar, or even
upon the boards of a theatre, are not rare in
modern times. The passion for notoriety too
frequently entertained by silly or weak persons,
when suddenly or rudely humbled, is often fol-
lowed by a state of extreme mental collapse or
depression, which sometimes terminates itself
in suicide. The shock produced by the failure
of long or warmly cherished hopes, of whatev-
er kind, either suddenly overwhelms all efforts
of reason and judgment — the suggestions and
impulses of passion and feeling being followed
without control — and thus induces at once a
state of moral insanity as harbingers of the su-
icidal act, or more slowly and surely develops
some one or other of the forms of mental dis-
ease above described. In either case, the en-
tertaining of the idea of self-destruction is an
indication of insanity, inasmuch as it is con-
nected with, or dependant upon an overthrow
of reason and judgment in the one, and a man-
ifest disorder of mind in the other. But, in
many instances, the act is perpetrated after the
first shock of a reverse or disappointment has
subsided — after Reason has resumed her sway,
and has been more or less exerted in calmly
combating the feelings and suggestions which
such reverse may have called into activity.
In these cases, the suicidal act is the result of
a weighing of the present and consequent mis-
ery — of the wretchedness attending upon ex-
isting and prospective emotions, against the
contingencies following the commission of this
crime ; and whatever of insanity may be pres-
ent consists only of the excessive emotions
which reverses occasion, relatively to the
strength of moral and religious principles by
which they are, or should be, controlled. Hence
it follows that a number of suicides are com-
mitted after disappointments, losses, &c., in a
state of mind not absolutely amounting to in-
sanity — during an impatience under misfortune,
unrestrained by these principles, owing either
to their weakness or absence. Various kinds
and grades of disappointment or misfortune
will lead to the commission of this crime, ac-
cording to the susceptibility of the mind, the
early education, the previous trials and tutor-
ing of the understanding, the preceding career
of success or amount of distinction, and vari-
ous accessory circumstances connected with
existing states of society and manners. The
most common, however, are losses of fortune
or of reputation, losses from gambling or from
transactions of this description, moral and
worldly humiliations, disappointed affection,
and the losses of friends, several of these being
combined in their operations upon the mind.

578. g. One cause of suicide, of no infre-
quent occurrence in the present state of socie-
ty, has been insufficiently considered by medi-
cal as well as psychological writers : this is,
the satiety and ennui consequent upon excessive
sensual gratifications, felt by minds imperfectly
or viciously educated, and unaccustomed to
those pains, privations, and contrarieties of life
that impart happiness to the enjoyments by
which they generally are sooner or later fol-
lowed. Continued and excessive gratifications

destroy the susceptibility and excitability of the
nervous system, and exhaust its manifestations.
The languor consequent upon enjoyment is not
allowed to subside, or to be succeeded by re-
newed vigour, before the indulgence is repeat-
ed ; and as languor and exhaustion increase
with the repetition of the gratification which
occasioned them, so the desire of escaping from
these unpleasant sensations becomes also in-
creased, and the want of varied and augmented
excitement is experienced. Thus gratification
begets desire, and desire calls for gratification,
until all its sources are exhausted, all its vari-
eties and grades are enjoyed ; and the sated
mind, no longer finding objects capable of ex-
citing it, or of enabling it to emerge from the
languor or depression consequent upon inordi-
nate enjoyment, and deriving pleasure no more
from the numerous sources which afford it to
better regulated minds, feels most bitterly that
" all is vanity and vexation of spirit." In the
career of gratification, moral and religious prin-
ciples are gradually, at first, departed from, and
ultimately altogether despised ; and once the
mind is no longer able to receive enjoyment
from the usual means, and has exhausted all the
sources of it within its reach, it has also ap-
proached the lowest grade of moral degradation,
which either takes refuge in suicide, or is ready
to have recourse to it, in moments of deep de-
pression, or on occasions of severe contrariety
or disappointment. The restraining influences
of principle, and of regard to reputation, have
ceased to influence the conduct ; and as soon
as the continued and varied indulgence has ex-
hausted vital and mental power, and dried up
every spring of enjoyment, circumstances which
depress or vex the mind will often give occa-
sion to suicide, or suggest it ; or the mind, no
longer being capable of gratification, entertains,
at first, the idea of suicide, and ultimately has
recourse to it, in order to escape from the mis-
ery of the extreme languor which it is incapa-
ble of dissipating. While most of the causes
of suicide, and especially those already noticed,
are of an active kind, this may be viewed as al-
together passive. While the former acts by
violently exciting and disturbing the mind, the
latter results from a defect of such excitements
as will rouse it, and afford those gratifications
without which it either cannot exist, or prefers
not to exist at all.

579. It has been said that a society for the
mutual encouragement of suicide exists in
Paris, the members of which undertake to ter-
minate their own existences when life becomes
insupportable ; and the circumstance is almost
verified by the character of the prevailing lit-
erature, and of the drama, in that capital. Nu-
merous are the instances, not only throughout
France, but also in this country, of persons
who, having run an unbroken and rapid career
of sensual gratification, and either exhausted
its sources or their own means of enjoyment,
have therefore put a period to their existence
without any farther reason, and without any
previous proofs of their insanity beyond the
inordinate indulgence of their desires and pas-
sions, and the predominant sway these had ob-
tained over all their sentiments and actions.

580. h. Closely allied to the preceding is the
occurrence of a morbid or irresistible impulse to
commit suicide, without obvious mental disorder,

640

INSANITY, SUICIDAL— Occasions of.

or any moral cause sufficient to account for the
act. Suicides of this kind occur most frequent-
ly in persons belonging to families hereditarily
prone to insanity or suicide ; and hence, in
some instances, may be viewed as the first
manifestation of the mental disorder. But they
likewise are committed by persons who are not
thus predisposed, and under circumstances
which require a brief examination. 1st. From
a species of mental sympathy or infection, caused
by perusing the details of cases of suicide fur-
nished so circumstantially and injuriously as
respects the minds of the community, by the
weekly and daily press. Instances are often
occurring, of not one only, but of several sui-
cides being committed during the first few days
following the publication of some notorious case
of self-murder — notorious as respects either the
rank of the individual, or the mode of perpe-
trating it, or other circumstances connected
with it. Such instances have been long re-
marked, and are of increasing frequency, owing
to the existing state of society, of which some
notice has already been taken (s^ 272, 320), and
to which a brief reference will hereafter be
made ; 2dly. Suicide is, in rare instances, per-
petrated from a species of fascination. The
very knowledge of having in hand the means,
or by a single step the power of self-destruc-
tion, may give occasion to the impulse of com-
mitting it, which may even be instantly carried
into effect by the weak, susceptible, or the mor-
bidly disposed mind. I have had, on several
occasions, to prescribe for highly nervous per-
sons—those labouring under a morbid sensibili-
ty of the nervous system, and anxious, suscep-
tible states of the moral feelings — who could
not handle a razor or sharp knife without being
distressed by the desire or the idea of attempt-
ing suicide. Such persons, also, are unable to
look down from great eminences, or over a
precipice, without experiencing a desire of
throwing themselves headlong. Byron has
noticed this feeling, and ascribed it to

" The lurking bias, be it truth or error.
To the unknown ; a secret prepossession,
To plunge with all our fears — but where? you know

not.
And that's the reason why you do— or do not."

The bias to the unknown, here noticed by the
poet, has little or no influence in originating
this singular feeling, which is sometimes expe-
rienced by persons both physically and morally
sane, as well as by the weak in mind and body.
This desire or impulse to precipitate one's self,
when looking downward from a very high pre-
cipice, obviously arises from no process of rea-
soning. Probably the suggestion of contrast
may be concerned in producing it ; and some-
thing may be owing to the unusual impression
made upon the mind through the sense of sight
— to the nature of the sensation itself That
this sensation is even pleasurable — that it is
attended by a sort of fascination — is admitted
by those who have experienced it ; and, with
many persons, the desire is so strong as to re-
quire the active exertion of reason to overcome
it. That it causes a physical as well as a mor-
al effect — that it affects the circulation in, as
well as the manifestations of the brain, is
shown by the vertigo which accompanies it,
and which often occurs without the desire of
self-precipitation or destruction

doubt much whether or not the feeling produced
in the mind by this impression on the sense of
sight is primarily attended by such a desire. It
would seem that the sensation is pleasurable,
and that it excites a desire to throw one's* self
headlong in the gratification of it. But reason
immediately dictates that this act would be at-
tended by self-destruction ; and from this the
sane mind recoils with a shudder — recoils from
the consequences of enjoying the feeling which
the nature of the sensation had thus suggested.
This subject, although noticed by Falret, An-
DRAL, and others, has not been hitherto inves-
tigated with reference to suicide. But it is
not improbable that persons who have enter-
tained the idea of self murder, and yet have
not been able to summon resolution to commit
it, knowing the influence of the sensation of
looking down from a precipice upon the mind,
have had recourse to it, in order to aid their
weak resolves. Others, probably, in states of
high susceptibility and extreme weakness of
the nervous power, have followed the impulse
or fascination thus produced, before reason had
time, or recovered power to counteract it.

581. i. Suicide may, under certain circum-
stances, become almost epidemic. Indeed, an
epidemic prevalence of the act has been noticed,
without any other causes beside those just sta-
ted to account for it. Sydenham has mention-
ed such an occurrence, and others have taken
place in more recent times. During the atro-
cities of the French Revolution — atrocities the
most humiliating in the history of the human
mind — the "damned spot" in the annals of
France, which neither her science can oblit-
erate, nor her military glory can conceal — sui-
cides were most prevalent, owing to a variety
of causes, and often to a combination of cir-
cumstances and feelings : the loss of honour,
fortune, and friends ; the impulses of passions,
and of remorse, despair, &c. The frequency
of suicides at certain periods and in particular
places is caused chiefly by political changes
and by commercial crises, affecting the position
of numerous individuals in society, mortify-
ing their pride and changing their prospects.
Something, also, may be imputed, on certain
occasions, to mental sympathy or imitation, and
somewhat even to a passion for notoriety ; but
impatience under misfortunes and disappoint-
ments is the most common cause. M. Andral
states, as proving the influence of imitation in
causing suicide, that one of the inmates of the
" Invalids^' was found hanged in a particular cor-
ridor. Two days afterward, a second was found
in the same place ; then a third, and even a
fourth.* This corridor was shut; afterwhichno
more hanged themselves. He farther remarks
that, not long ago, it was the fashion for people
to throw themselves from the top of the column
in the Place Vendome. This was, however,
only a fashionable mode of committing an act
which is always common in Paris, and which
was not the more frequent because tliis mode
was preferred to the other means more usually
adopted. It has often been noticed, in most
civilized as well as uncivilized countries, and
particularly in communities closely associated
by feelings and interests, as in regiments, &.c.,

* [Tt is related that 1300 people destroyed themselves in
Versailles in 1793 ; and that in one year, 1506, sixty per-
Indeed, I ished by their own hands in Rouen.]

INSANITY, SUICIDAI.— Occasions of.

641

that a single instance of self-murder is soon
followed by many.

58a. k. Self-murder has been often perpetra-
ted in order to escape exposure and punishment
consequent upon detected crimes. Indeed, this
is one of the most common moral causes of
suicide in this and other civilized countries,
and instances of it are of daily occurrence.
Many of the actors and prime movers in the
unprecedented atrocities of the French Revo-
lution committed or attempted suicide when
they came, in their turn, to experience a direful
retribution. Criminals of all grades, from the
petty depredator to the state delinquent, have
sought refuge in self-murder from the accusa-
tions of conscience, the shame of exposure, and
the extreme wretchedness attending conviction
and the last penalties of the laws. Detection
of, as well as remorse caused by conjugal infi-
delity, has been followed by suicide. In the
one case, this act is resorted to in order to
avoid the exposure and shame consequent upon
detection, although remorse influences the
mind, in part, to form the resolution ; in the
other, self-reproach is often the sole cause.

583. The desire of escaping from moral or
physical pain, or from anticipated or impending
want, is not infrequently productive of self-de-
struction. Under this head may be comprised se-
duction and despair, however produced. How nu-
merous are instances of suicide caused by the
despair consequent upon seduction, the deser-
tion of the seducer, and all the contingent mis-
eries, heightened by the fears and anticipations
of the seduced, by the desertion of friends, and
the scorn of society. Pkysical pain is much
less frequently a cause of suicide than moral
suffering. jMany, however, of the ancient Sto-
ics put an end to pain by terminating their
lives : thereby following the example of Zeno,
the founder of their sect ; and several Romans
have been mentioned by Pliny and others as
having adopted this course. Dr. Haslam states
that a gentleman destroyed himself to escape
from the tortures of gout. I have been told
by several persons that, while suffering the
pangs of neuralgia, it required the utmost ef-
forts of their moral principles to restrain them
from perpetrating self-murder. Numerous in-
stances are on record of persons who, having
believed themselves suffering incurable mala-
dies, have had recourse to suicide as a more
pleasant mode of dying ; this crime being com-
mitted by them under the impression that a
natural death is more painful than that inflicted
by themselves. It has, however, been long
known, and shown by IIufeland andW. Phil-
ip, that death from disease, even when the
mental faculties are retained lo nearly the last,
IS attended by a gradual abolition of the gen-
eral sensibility that is by no means painful or
distressing ; the patient ceasing to exist as
happily and calmly as when falling asleep, un-
less under peculiar circumstances.

684. /. Suicide is often committed in states
of irritatian and chagrin, particularly by persons
of a morose, splenetic, or irritable temper. It
is sometimes suggested to such persons by a
desire to excite regrets or self-reproach in the
minds of those who have offended them, by a
feeling of revenge. Most of the suicides com-
mitted by children are caused by a desire of
this kind, particularly when they follow punish-
II 81

ment of any description. Self-murder arising
from jealousy, also, depends chiefly upon the
promptings of this feeling in connexion with
anger, and is most apt to occur in hysterical,
nervous, or weak-minded females. Some years
ago I was present at an evening party, where
a young lady, engaged to a gentleman present,
was seized with hysterical convulsions in con-
seiiuence of his attention to another. Upon
recovering from them, she suddenly left the
house, without the direction she took being ob-
served. The following day she was taken out
of the canal near the Regent's Park, in her
ball-dress, she having gone upward of a mile in
order to carry her design into execution. A
lady, on a similar occasion, took a large quan-
tity of laudanum. The usual means of resto-
ration producing no effect, I was sent for : sho
was ultimately recovered by the affusion of
cold water on the head.

[We were recently called to resuscitate a
young lady, aged sixteen, who had thrown her-
self into the Hudson River because her mother
wished to send her on an errand in Broadway
in her ordinary dress, thus exposing her to the
public in an attire very decent, but not as fash-
ionable as she thought necessary. Our at-
tempt, however, was unsuccessful. No other
cause for the rash act could be assigned. Bur-
rows speaks of a girl but little over ten years
of age, who, on being reproved for some trifling
indiscretion, cried and sobbed bitterly, went up
stairs, and hung herself in a pair of cotton bra-
ces ; and of another, eleven years old, who
drowned herself for fiear of simple correction.
A French journal has recently reported the
case of a boy, twelve years old, who hung him-
self by fastening his liandkerchief to a nail in
the wall, and passing a loop of it around his
neck, for no other reason than because he had
been shut up in his room, and allowed only dry
bread, as a punishment for breaking his father's
watch. J

585. Domestic contrarieties and misery — the
frequent recurrence of petty vexations — the
tyranny of intimate connexions, and the posi-
tive ill-usage of others — suits in courts mis-
called those of equity, on the lucus a non lucendo
principle — may, from their continuance, severi-
ty, and repetition, especially under aggravating
circumstances, and in states of high suscepti-
bility in the unhappy sufferer, drive even the
strong-minded and the well-principled into a
state of temporary despair or desperation — may
tire the brain to madness, during which self-
destruction may be attempted. A most talent-
ed and accomplished young lady, suffering from
a combination of the above circumstances, took,
upon retiring to rest, and with a suicidal inten-
tion, a very large quantity of laudanum, more
than is usually productive of a fatal effect. She
wakened late the following day with a most
distracting headache and general disorder, rec-
ollected tiie act of the previous night, regretted
the attempt, and sent for medical aid, deter-
mined, however, to conceal the cause. Her
health, from this and the other circumstances
alluded to, continued greatly impaired for many
years, and several physicians were consulted.
She came under my care, and at last men-
tioned the suicidal attempt, which was never
farther divulged. She now continues, in good
health, to ornament the society ia which she

642

INSANITY, SUICIDAL— Occasions of.

moves. M. Falret mentions, among other
causes of chagrin producing suicide, that of
having been calumniated ; and he states, that
a considerable number of persons commit this
act chiefly with a desire of vindicating their
reputation, no other means of vindication being
in their power.

586. The state of desperation into which a
person influenced by the passion of love may be
thrown by disappointment is actually that of
insanity, at least, of moral insanity. A gentle-
man endeavoured to obtain the favourable no-
tice of a lady, of whom he had become enam-
oured, but had not succeeded. He committed
suicide by opening a vein in his arm, and,
while the blood was flowing, he wrote a note
with it, acquainting her with his act. She was
soon after attacked by nervous fever, which
was followed by insanity, during which she
fancied that she heard a voice commanding her
to commit suicide. Other instances of a simi-
lar kind may be adduced.

587. Some persons, during intoxication, have
a remarkable disposition to commit self-murder.
This disposition may be the consequence of ei-
ther habitual or occasional intoxication ; and
it is sometimes connected with delirium tremens,
or, rather, depending upon the illusions attend-
ing that disease. Some persons, who have re-
ceived at a former period of their lives severe
injuries of the head, experience this disposition
when even but slightly affected in other re-
spects, by intoxicating liquors, especially if they
suffer any contrariety or opposition at this time.
Cases of this kind have been noticed by M. Fal-
BET and others, and by the author.

584. VI. Instances of mutual or associated sui-
cide are not rare, particularly in recent times.
The self-homicides of Lucius Verus, Sextia,
and PoLLUTiA, during the reign of Nero, and
of Sardanapalus, may be noticed among the
many instances recorded in ancient history.
During the French Revolution, and the wars
consequent upon it, associated suicides were
frequent. Nine conscripts who had concealed
themselves, having been discovered, deter-
mined to destroy themselves rather than serve :
they drowned themselves together. The most
common causes of this mutual crime are, op-
position on the parts of parents to the fulfil-
ment of marriage engagements entered into by
young persons, want or disappointments in the
married state, and family dishonour. The
bodies of two young persons were found in the
Seine with a piece of paper attached to them,
testifying to their ardent affection, and that
they perished together that they might be eter-
nally united. Occurrences of this kind are,
however, not unfrequent in this and other civ-
ilized countries ; and instances are not rare of
lovers committing mutual suicide, even where
there was no opposition to the consummation
of their wishes. In this latter case, some cause
of chagrin or disappointment has occurred, and
maddened the mind already disordered by one
dominant passion, the suicidal intention enter-
tained by either being adopted by the other.
From the accounts of several cases of mutual
suicide attempted in recent times, there is every
reason to suppose that the attempt was merely
simulated by one of the persons who had agreed
to commit this crime ; and that it had been
contrived entirely with the intention of getting

rid of an object no longer one of endearment.
This is more likely to be the case when a young
woman has become pregnant by one of those
drunken, debased workmen, who prey upon fe-
males in large or manufacturing towns. This
and similar instances have appeared in the pub-
lic prints. A man out of work, and his para-
mour, having agreed to commit mutual suicide,
procured some laudanum (about four ounces),
and divided it into two equal quantities. The
man proposed that they should turn back to
back while taking it, in order that they might
not falter in the act. The female died soon
after, but the man did not appear to be affect-
ed. From the evidence at the inquest, it did
not appear that he had actually entertained an
intention to destroy himself, or had taken any
of the laudanum. Analogous cases have oc-
curred where drowning has been the mode of
carrying the suicidal act into effect, one of the
parties having escaped.

589. Want and other causes of distress, and
even more petty grievances, may, in states of
mind but little influenced by moral and religious
principles, induce husband and wife to commit
mutual suicide. In the present state of society,
especially in Paris, where the passions are
roused and excessively gratified before reason
and judgment are informed — where sensibility
is exhausted at an early age by the excitement
of sensations in great variety, in rapid succes-
sion, and increasing intensity — where the thirst
for pleasure is promoted by a loose and stimu-
lating literature — and where the end of enjoy
ment is generally shown, in the pages of tha
novelist and in the scenes of the dramatist, to
be nmrder and suicide — instances of associated
self-destruction, even among persons in no way
dependant upon each other, have not been rare.
Young men, who have exhausted either the
means or the power of enjoyment, or both, in
the career of vicious indulgence, and unre-
strained by principle and by fear, have followed
the example held out to them by the popular
writers of the day, and " shuffled off this mor-
tal coil" in the most dramatic forms they could
devise. Two young men entered a restaurant,
ordered an expensive dinner, with costly wines,
without the intention or the means of paying
for it, and soon afterward committed suicide
together. On a table in their room were found
written papers expressing aspirations after
greatness without either labour or care, and
contempt for those who could live by their own
exertions, with sundry quotations from Victor
Hugo and other exciting writers of the day.
The whole was terminated by a request that
their names and the manner of their deaths
might be sent to the newspapers ! Sensation
is the object and end of living with many in the
present day ; and when it can no longer be ex-
cited—at least, to the pitch, or in the tone, ca-
pable of yielding enjoyment — life is relinquished
in such a way as is most likely to excite the
sensations of others.

590. 71. Murder is often committed first, and
suicide afterward, prompted by the same or dif-
ferent motives. Jealousy is one of the most
frequent causes of this combination of crimes,
which, however, may be prompted by a variety
of circumstances, indeed, by all which occasion
suicide or insanity. The following instances
are fully detailed by Mr. Winslow : M. De Pon-

INSANITY, SUICIDAL— Occasions of.

643

talba, whose son was a most distinguished of-
ficer, and married to a most extravagant wom-
an, saw with distress the ruin she was bring-
ing upon him. In order to save the son, the
father shot the daughter-in-law, and afterward
himself. A gentleman of London was married
in the country to the object of his affections.
He had drawn the charge from his pistols the
previous night, but his servant had loaded them
again the following morning without acquaint-
ing him. After the ceremony he took up one
of the pistols, which he knew he had unloaded
the night before, and playfully rallied the lady
on her cruelty, saying, " You shall die, you ty-
rant ! you shall die with all those instruments
of death about you — with that enchanting smile,
those killing ringlets of your hair !" " Fire !"
said she, laughing. He pulled the trigger, and
she was shot dead. He called up the servant,
and, upon his entering, locked the door, and in-
quired if he had loaded the pistols. " Yes,"
was answered ; on which his master shot him
with the undischarged pistol. He wrote* to
his wife's father, explaining the calamity, and
then threw himself upon his sword.

591. Instances are not rare of a parent or pa-
rents, influenced cither by want or by homici-
dal monomania, killing their children, and then
committing suicide. Although extreme wretch-
edness is sometimes the chief occasion of these
occurrences, yet it is seldom the only occasion.
More frequently some form of partial insanity
is either the principalor concurring cause ; some
circumstance having occurred to excite the
homicidal propensity. Dr. Gall mentions the
case of a soldier, of whose wife an officer had
become enamoured without succeeding in his
wishes. The soldier appeared dejected and
morose, but the following day appeared quite
tranquil. A few days afterward he and his
wife attended the confessional and took the
sacrament ; they dined in good spirits, and went
out to walk ; he expressed his strong affection
for her, and inquired if she had made a full con-
fession to the priest. He then plunged a pon-
iard in her breast. He repaired to his house,
and seizing his children, killed them with a
hatchet. He afterward went to the main guard
and deliberately detailed the whole particulars,
concluding with the words, "Let the officer
now make love to my wife, if he pleases !"' He
then stabbed himself to the heart.

529. 0. Suicide is often simulated, with a
view of obtaining a desired end ; the lover
threatens or seems to attempt it, to induce a re-
turn of his affection ; the spoiled child, to obtain
a compliance with his wishes ; and the indul-

* The letter >^iU show the state of mind produced by
causing the death of a much-loved ol)ject, particularly as
yeading to suicide. This gpntleinan had written immediate-
ly upon the perfoniiance of the ceremony, and had conclu-
ded the note as follows : " The bnde gives her duly, and is
as handsome as an angel. I am the happiest man breath-
ing." This sonii afterward was written : " Two hours ago,
I told you truly that I was the happiest man alive. Your
daughter lies dead at my feet, killed by my own hand, through
a mistake of iny man's charging my pistols unknown to me !
I have murdered him for it. Such is my wedding-day. I
will follow my wife to her grave ; but, before I throw my-
self upon my sword, I command my distraction, so far as to
explain my story to you. I fear that my heart will not
keep together till I have slabbed it. Poor good old man, re-
member that he who killed your daughter died for it ! In
death, I give you thanks, and pray for you, though I dare
iiot pray for myself. If it be possible, do not curse me.
Farewell for ever 1"

ged wife, submission to her caprices. In such
cases, either a small portion of laudanum is
usually procured, and this is diluted with some
fluid, to increase the apparent quantity ; or a
large quantity is taken, when seen by some per-
son, or when instant aid may be obtained. Fe-
males have resorted to this plan to try the af-
fection, or to compel the fulfilment of the en-
gagements of their lovers ; but, in cases of
this kind, little more is necessary to be known
than that such acts are sometimes resorted to ;
and that a poisonous dose may be actually ta-
ken, in order to appear the more in earnest,
knowing that assistance is near, and that it will
be successfully employed. Drowning, even, may
be feigned in similar circumstances. I have,
however, seen two cases in which fatal results
very nearly followed this experiment upon the
endurance of affection.

593. B. Predisponcnt Circumstances. — Besides
the above exciting occasions of suicide, others,
which powerfully predispose the mind to their
influence, and to which attention has been im-
perfectly directed, require to be briefly noticed,
namely, hereditary predisposition ; systems of
philosophy and of morals ; states of education, of
manners, and of society ; distracting subjects and
studies ; irritation caused by difficult and perplex-
ing circumstances ; injuries of the head, and phys-
ical disease ; the influence of climate, of seasons,
weather, and states of the air on the nervous sys-
tem, and of age, sex, and temperament, &c.

594. a. The influence o( hereditary predisposi-
tion in occasioning suicide is well established.
In a very large proportion of instances, either
self-murder has been perpetrated by one of the
older members of the family, or some form or
other of insanity has appeared in one or more
of them. Very frequently one or both parents
of the suicide have been noted for eccentricity,
or the waywardness, instability, or violence of
their dispositions and tempers. Instances have
occurred of the children of a parent who has
committed self-destruction perpetrating the
same act when they have grown up, or at later
periods of their existence. Even more than
one — several — of the offspring have experien-
ced this fatal disposition upon arriving at near-
ly the same epoch of life as that at which it
was committed by their parent. Dr. Gall has
observed the suicidal predisposition in several
successive generations. I have known it in
three generations. M. Falret considers sui-
cide to be more intimately dependant upon he-
reditary predisposition than any other form of
insanity ; but this is chiefly the case in respect
of suicide connected with melancholia and oth-
er forms of partial insanity.

[We could relate several instances of a he-
reditary predisposition to suicide that have oc-
curred under our own observation. Dr. Gall
relates the following very remarkable case :
"The Sieur Gauthier, the owner of various
houses built without the barriers of Paris, to be
used as entrepots of goods, left seven children,
and a fortune of about two millions of francs
to be divided among them. All remained at
Paris, or in the neighbourhood, and preserved
their patrimony ; some even increased it by
commercial speculations. None of them met
with any real misfortunes, but all enjoyed good
health, a competency, and general esteem All,
however, were possessed with a rage for sui-

644

INSANITY, SUICIDAL— Occasions of.

cide ; and all seven succumbed to it within the
space of thirty or forty years. Some hanged,
some drowned themselves, and others blew out
their brains. One of the first two had invited
sixteen persons to dine with him one Sunday :
the company collected, the dinner was served,
and the guests were at the table : the master
of the house was called, but did not answer.
He was found hanging in the garret. Scarcely
an hour before, he was quietly giving orders to
the servants, and chatting with his friends. The
last, the owner of a house in the Rue de Rich-
elieu, having raised his house two stories, be-
came frightened at the expense, imagined him-
self ruined, and was anxious to kill himself
Thrice they prevented him ; but soon after he
was found dead, shot by a pistol. The estate,
after all the debts were paid, amounted to
300,000 francs, and he might have been 45
years old at the time of his death."]

595. b. The influence of systems of philosophy
and of morals in increasing the frequency of
suicide is undoubted. The doctrines of Zend
and Epicurus encouraged it among the an-
cients. Since the revival of learning, Mon-
taigne was one of the earliest and ablest of
those who favoured the perpetration of this act,
but all his arguments are derived from the an-
cient Stoics. The early writings of Dr. Donne
seemed to favour suicide ; but they actually go
no farther than to show that contempt for, or
even the sacrifice of life is praiseworthy in the
discharge of our duties, and in the execution of
beneficent and noble undertakings. The rea-
sonings of Hume, and the indirect support which
the doctrine they favour received from the wri-
tings of Montesquieu, of Rousseau, of Gothe,
De Stael, and others, probably contributed less
than is supposed to the increase of this crime.
It is, however, not to be disputed that the loose
principles disseminated, and the violent feelings
displayed and exerted, by the warm and pas-
sionate writings of Rousseau and Gothe, pro-
moted this end much more than the metaphys-
ical and moral arguments urged in favour of it.
Madame De Stael has stated that the Sorroivs
of Wertcr caused more suicides, at one time, in
Germany, than all other circumstances com-
bined. Whatever of mischief has arisen in this
direction from modern writings has been indi-
rect — has proceeded chiefly from the injurious
influence exerted upon the mind by an exciting,
profligate, and debauching literature, for which
the state of society and manners has procured
a very extensive circulation ; and not so much
from the arguments adduced by a few meta-
physical writers of more confined, although
more lasting reputations. The poison instilled
continually, and in wide profusion, into the
minds of all classes of the community, through
the media of the numerous works of passion
and imagination with which the presses of the
civilized world at present labour ; the taste for
their perusal, which numerous circumstances
of the times conspire to diffuse ; and the moral
contamination which they spread, or render
still more deep and malignant, most sensibly
dispose the mind to suicidal impulses, when
subjected to the exciting causes already no-
ticed. That the doctrine of Matcrmltsm, how-
ever, and the general skepticism to which it
leads, disposes the mind to suicide, inasmuch
as it weakens the belief of a future state of re-

wards and punishments, cannot be disputed.
The mfidelily so widely diffused towards the
close of the last century, by means of the skep-
tical writings of that, and of a somewhat earlier
period, doubtless contributed to the frequency
of suicide, especially in France, during that
eventful epoch ; and there is every reason to
believe that its influence is still exerted, al-
though to a somewhat less extent than then.

596. c. Education and stales of maimers and of
society may be such as to favour, or to counter-
act a tendency to self-murder. If education be
conducted without regard to religious and mor-
al principles — if the knowledge of words, of
things, of facts, and of phenomena be made to
supersede sound principles of conduct and of
belief — if the amount of knowledge communi-
cated rise above, or reach beyond the sphere
of utility and of enjoyment — if, in short, educa-
tion be conducted in the manner in which I
have already shown it (^ 271, 272) to be gener-
ally conducted in the present day, it will tend
much more to increase the number of our wants,
to develop our desires and passions, to aug-
ment their intensity and violence, at the same
time that it removes from them those salutary
restraints which prevent them from becoming
dangerous to others or destructive to ourselves.
The influence of education thus loosely con-
ducted, upon the pseudo-liberal principle of ren-
dering it acceptable to all creeds — to the Church-
man, the Romanist, the Presbyter, the Baptist,
the Socinian, and all other persuasions — " to
Christian, Turk, and Jew" — proves injurious,
not only in the way just stated, but also in giv-
ing rise to forced, unnatural, over-reaching, am-
bitious, and unprincipled states of society ; and
these states, in proportion as they are devel-
oped, are the parents of crime, insanity, and
suicide. Throughout the community, and par-
ticularly in the middle classes, there is a con-
stant effort to rise above the ranks which Prov-
idence has assigned, and to partake of the
pleasures and luxuries which are far beyond
the means of some, and are conducive to lib-
ertinism and profligacy in many of those who
enjoy them the most. The end of excessive
indulgences, and of debauchery in every form,
particularly when early pursued, is suicide or
insanity, or the unequivocal combination of
both, in many instances.

597. There can be no doubt of the perni-
cious principles recently inculcated, particularly
among the lower orders of society, and to which
the name of Socialism has been given, having
already conduced, in several cases, to suicide.
This doctrine, inasmuch as it unlooses the ties
of society and of consanguinity, as it admits of
no moral responsibility, and as it allows no ex-
pectations of future rewards and punishments,
is opposed to all moral and religious obliga-
tions — it favours vice and profligacy, overthrows
all virtuous and salutary restraints upon the
feelings, and, by allowing without control the
indulgence of the desires and passions, favours
what has just been shown to be the ultimate
consequences of this course. In this state of
society, the endearments of friends, of connex-
ions, and even of relations, cease to exist. The
ties which i)ind society together in harmony
are broken asunder; and as soon as the race
of selfish indulgence is run — as the power of
enjoyment is exhausted — the mind, having no

INSANITY, SUICIDAL— Occasions of.

645

affections, no friendships, no self-consoling and
truly gratifying recollections to repose upon,
at once sinks into a state of abject wretched-
ness, which it seeks to terminate by self-mur-
der.

598. In illustration of what I have stated, I
may adduce what has been advanced by a
French writer, in accounting for the frequency
of suicide. This writer remarks, that the high
civilization and refinement, the luxury, the
clash of interests, the repeated political chan-
ges, combine to keep the moral feelings of tbe
Parisians in a state of tension. Life does not
roll on in a peaceful and steady current, but
rushes onward with the force and precipitation
of a torrent. In the terrible struggle, it often
happens that the small minority, which has
been elevated high above the multitude for a
lime, falls down as suddenly as it has risen.
The drama of life is full of miscalculations, dis-
appointments, disgust, and despair ; hence the
numerous suicides. But there are other caus-
es in operation — and not the least, the remark-
able character which romances, plays, and spec-
tacles have assumed. The public taste has un-
dergone a complete revolution in this respect.
Notliing is more patronised now at the theatre
than the display of crime unpunished, human
misery unconsoled, and a low literature, im-
pregnated by a spurious philcsophy, declaiming
against society, againt domestic life, against
virtue itself; applauding the vengeance of the
assassin, and recognising genius only as it is
seen in company with spleen, poison, and pis-
tols. This writer concludes with appealing to
those who read the novels of the present day,
and who visit the theatres, whether he has ex-
aggerated his statement ; and I may appeal to
all in this country, who are acquainted, not
only with the state of our popular literature,
and of the stage, but also with the character of
the daily, weekly, and even monthly publica-
tions, which are hourly devoured by all classes
— with their natures and contents— whether
this writer has not under-estimated the influ-
ence of these causes.

[These remarks will apply, it is believed, with
still greater force to the theatrical representa-
tions and the light literature of our own country.
The poison disseminated by these two sources
can scarcely be imagined ; and, what is worse,
the evil not only goes on unheeded, but no at-
tempt/are made to bring about a reformation.
The more licentious and profligate the charac-
ter of the daily press, the more is it patronised ;
and papers that do not cater for the very low-
est passions of our nature, and are not well
spiced with scandal, obscenity, and records of
crimes, are but little in demand, and soon give
place to others of an opposite character. The
trashy, miserable novels of the Hulwer and
Paul de Kock style, for want of an internation-
al copyright law, flood our whole country ; and
what else can be expected than a gradual de-
generation of morals, crime, insanity, and sui-
cide 1 It is time that parents, guardians, and
teachers, if not legislators, should take this
matter in hand, and display as much solicitude
against causes that poison the soul as those
that contaminate the body.]

599. d. Harassing- subjects and abstract stud-
ies, especially when undertaken by minds which
have undergone an imperfect preliminary course

of information and discipline, sometimes occa-
sion so much distraction as to give rise to sui-
cide or some form of insanity. Several instan-
ces of suicide have occurred from the pursuit
of subjects too abstract either in themselves,
or in relation to the power of the individual's
mind. In such cases, an extreme state of irri-
tability of temper is often evinced before the
suicidal act is attempted. ' Indeed, the irrita-
tion produced by any difficult and perplexing
circumstance, as well as by great losses and
disappointments, is very apt to terminate itself
in self-murder, when experienced by the weak,
the indulged, the fortunate, or the undecided
and wavering mind. In the present general
scramble for wealth, often merely for existence,
and as often only to obtain the means of re-
taining a position falsely usurped, or too san-
guinely entered upon, the irritation and distrac-
tion which often necessarily result, not mfre-
quently lead on to suicide. The rich man
gambles in the funds, foreign or domestic, or
in joint-stock shares, [railroad projects,] or in
the prices of foreign and domestic produce, in
order to double by a single speculation what
he had slowly acquired by prudence or applica-
tion. The poor man places his last or only
stake, and his own and his family's happiness,
upon a contingency not more secure than the
hazard of a die. In either case, adverse for-
tune brings distraction, which reason is not al-
ways able to calm. A gentleman, who had ac-
quired a large fortune by k long life of prudent
application to business, ventured the greatest
part of it in the foreign funds : he might, at one
time, have sold with great advantage ; but they
fell rapidly ; and, under the contemplated loss
of .£70,000, he terminated his existence. An-
other, similarly circumstanced, went repeated-
ly with the intention of selling at a time when
he might have gained many thousands. Ilis
want of decision prevented him on each occa-
sion from carrying his design into execution :
the period of extricating himself had passed ;
and, in a state of irritation at his loss, and at
his wavering state of mind, he committed sui-
cide. But such occurrences almost daily take
place ; for trading and commercial transactions
very generally possess, in the present day, very
much of the same gambling character. Even
the small capitalist is desirous of investing, or
of speculating with the savings of years, in
some one or other of the numerous schemes,
promising large returns, concocted by those
who are well aware of the existing passion for
gain, and who know well how to turn it to their
own advantage, but to the loss, misery, and
destruction of their dupes, many of whom, in
a state of distraction occasioned by their ruin,
commit suicide.

600. e. Injuries of the head, and physical dis-
ease, sometimes either predispose, or directly
give occasion to suicide. Injuries received at
a remote period may give rise to it, without
having previously excited any marked state of
disea.se, or even mental disorder ; and yet, upon
examination after death, lesions of structure
have been, in some instances, detected either
in the brain or its membranes, or even in both.
More frequently, however, physical disease,
often slight, but still manifest, shows itself; or
some degree of mental disorder, or some illu-
sion, is evinced, of which the suicidal impulse

INSANITY, SUICIDAL— Occasions op.

is only a symptom or a concomitant. In most
cases, the injury which originated the mischief
has been so slight as to be considered unim-
portant by both the patient and his friends.

601. Visceral disease has a similar influence
in causing suicide, as I have shown it above
(ij 309, et seq.) to exert in producing insanity.
When the abdominal viscera, particularly the
digestive organs, are chiefly in fault, hypochon-
driasis and melancholia are first developed ; the
disorder of these organs acting upon, or disor-
dering the circulation in the brain. When the
intention or the impulse to commit self-murder
originates in primary disease of the brain itself,
some form of monomania, or of mania gener-
ally either precedes or attends it. In most
cases of suicide arising from visceral disease,
either organic nervous energy has been remark-
ably depressed by exhausting causes, as by
masturbation, drunkenness, and libertinism ; or
this disease has been only an accidental or con-
curring cause, one or more of the circumstan-
ces or occasions already noticed having been
more or less concerned in producing the suici-
dal determination.

602. /. Seaso7is, weather, and climate have been
generally supposed to exert some influence in
disposing to suicide. M. Villeneuve considers
that a warm, cloudy, and humid state of the air
increased the number of suicides in Paris, Mar-
seilles, and Rouen ; and that stormy weather
seemed to e.xert a similar influence. The effect
of warm and humid states of the air upon the
nervous system is often very manifest in de-
pressing its energies, in weakening the mental
powers, and in lowering the spirits. The great-
est number of suicides has been said to occur
when the thermometer ranges above 75°. Dr.
Burrows observes, that, on examining the
tables kept at Westminster from 1812 to 1821
inclusive, and at Hamburgh from 1816 to 1822
inclusive, the number of suicides in both cities
was greatest in July, and least in October. A
similar result has been remarked in respect of
Rouen and Copenhagen. From 1817 to 1826,
the number of suicides committed in Paris
amounted to 3205 ; of which 997 were perpe-
trated in spring, 933 in summer, 627 in autumn,
and 648 in winter ; the following being the num-
bers with reference to the months: January,
213; February, 218; March, 275; April, 374;
May, 328; June, 336; July, 301 ; August, 296;
September, 248 ; October, 198 ; November,
131 ; December, 217. November has been said
to occasion greater despondency and despair,
and more suicides, than any other month ; yet
this month, both in London and in Paris, pre-
sents the smallest number of self-murders, with
the exception of October. Notwithstanding
the influence of warmth and humidity of at-
mosphere in increasing the number of suicides,
this act is much more common in the colder
than in the warmer countries of Europe ;
France, Germany, England, and Denmark be-
ing the kingdoms in which it is most frequently
committed. In the summer of 1800, 60 cases
took place in Rouen, and nearly 300 in Copen-
hagen ; the weather being warm and moist.
In Berlin, 500 instances occurred in six years
and a half; while at Naples there were, in 1826,
only 7, in a population of 349,000 ; and in all
Spain, in the same year, there were only 16
cases. Dr. Kamptz, of Berlin, has assigned

the proportion which suicides bore to the pop-
ulation, in several places in Europe, for the
year 1817. I abstract only a few cities :

Berlin . . 57 suicides, 166,584 popul., or 0,34 in 1000.
Breslau . . 58 — 63,020 — or 0,92 in 1000.

Magdeburgh 50 — 27,869 — or 1,79 in 1000.

Copenhagen 51 — 84,000 — or 0,60 in 1000.

Pans . . 300 — 700,000 — or0,42in 1000.

London . . 200 — 100,000,000 — or 0,20 in 1000.

No just inference, however, can be drawn from
returns of the suicides committed during one
year only in different climates or countries ; as
several circumstances, either uncommon or for-
tuitous, may have occurred, in one or more of
these climates, at that period, to increase or
diminish the usual numbers, as great prosperity
or adversity, plenty or scarcity, political com-
motions or revolutions, &c. Nor is it to climate
or season that much influence is to be imputed
in occasioning suicide ; but chiefly to the va-
rious circumstances already noticed in connex-
ion with religion, commercial speculation, and
states of society. It is sufficiently established,
however, that, throughout the most of Europe,
and in the United States of America, suicides
have become much more frequent than at the
above, or at almost any preceding period, un-
less during the French Revolution. The num-
ber has increased in Paris from 300 in 1817, to
511 in 1826 ; and in Copenhagen from 209 du-
ring 1790 and the four successive years, to 319
during the first five of the nineteenth century.
603. The admitted increase of suicides, more
especially in this country, is not to be altogeth-
er referred to the more general influence of the
several occasions already mentioned ; but in a
great measure, also, to the increased numbers
and circulation of those prints which abound
with the disgusting details of profligacy, crime,
and suicide. Dr. Burrows justly remarks,
" that the public taste has become more and
more vitiated and debased by this species of
gratification ; and nothing is found so attractive
as tales of horror and of wonder, every inquest
that is held upon a person who has destroyed
himself being read with great avidity." The
ludicrous police reports of criminal acts fur-
nished by the daily panderers to our more de-
based desires, scenic representations of success-
ful vice and crime, and the constant circulation
of suicidal acts in all the periodical prints, serve
most essentially to familiarize the minds of the
lower classes especially with these acts, and
to diminish the detestation with which they
are generally viewed at first, until the moral
sensibility becomes altogether blunted by theiT
perusal. The repeated presentations of these
crimes to the minds of the ignorant and vicious,
often not only divested of their attendant hor-
rors, but even clothed in attractive garbs, read-
ily suggest a recourse to them in circumstances
which cause distress, irritation, or distraction.
Literature, if, indeed, the trash vomited hourly
from the steam-press should be dignified with
the name, has become the most debased of
modern ways of traffic ; and its chief end, in
the present day, is to encourage those feelings
and desires by means of which its diffusion
and profitable returns may be augmented. In
order that this may be the more surely effected,
and with the greatest amount of moral contam-
ination to the community, and of pecuniary
profit to the writers and proprietors — that the
criminal appetite may be pampered andincreas-

INSANITY, SUICIDAL— Occasions or.

647

ed ; that each successive meal of criminal in-
dulgence may be followed by a greater relish
and a more craving desire for its repetition —
foreign countries are ransacked to furnish what
our own cannot supply in sufficient frequency
and piquancy.

604:. ff. Age and Sex. — The frequency of su-
icide varies at different ages. During the early
epochs of existence, the sanguine expectations,
•shich are generally indulged, and which soon
take the place of temporary despondency and
distraction occasioned by disappointments and
los.ses. tend to diminish the number of suicides.
In the middle and more advanced periods of life,
sensibility becomes exhausted or blunted, while
cares and anxieties increase in number and in-
tensity ; and the attachment to life is much im-
paired. The desire of life afterward increases,
and frequently in proportion as old age advan-
ces. M. Falret has shown that it is from 35 to
45 that the greatest number of suicides occur.
Of 6782 cases, 678 were under 20 years of age ;
and of this number 487 were between 15 and
20, and 181 below the age of 15. A child of
nine years old* wished to destroy itself; but
this is the only case of so early an age. After
45, suicide becomes more and more rare ; and
above 70, there are scarcely any instances of
it. The father, however, of the celebrated
Barthez killed himself at the age of 90 ; and
his son, when he was old, wished to follow his
example.

605. Both sexes display the suicidal tendency,
but the male sex most frequently. M. Esquirol
considers the proportion of males to females to
be three to one ; but there are ditferences ac-
cording to countries, arising from the greater
or less influence of many of the circumstances
shown to favour this act. Thus, in France,
there are more suicides among women than in
Germany. It has been observed, both in Eng-
land and on the Continent, that nearly two
thirds of suicides were unmarried. This state,
therefore, is much more favourable to self-
destruction than the married condition.

606. h. Suicides are most frequent among
persons of the melancholic temperament and bil-
ious constilulion, with a pale or sallow, or yel-
lowish complexion, and hard or sharp features.
Such persons are more liable than others to dis-
orders of the biliary and digestive organs. But
this crime is not infrequently committed by the
nervous and irritable, and even by the sanguine
and plethoric. Females of this latter constitu-
tion occasionally attempt or perpetrate self-
murder just before or during the catamenia, or
from some irregularity of this evacuation. M.
Esquirol states, that the scrofulous diathesis is
remarkable in a number of suicides.

607 I. Several tables, showing the frequency
of the several causes of suicide, have been pub-
lished, but are obviously deficient in precision,
as well as in the truth of the data upon which
they are based. Moreover, this act is not gen-
erally prompted by a single circumstance or
cause only, but by the combination, concur-
rence, or succession of several. With great
allowances and reservation, the following may
be adduced, in the absence of more accurate
information, as to the comparative influence of

* I am now attsndingr, for a physical ailment, a boy of 12
years of age, who altenipted suicide by banging, from a feel-
ing of revenge for being punished.

the circumstances occasioning this crime. The
suicides committed in London, between the
years 1770 and 1830, have been stated (London
Med. and Surg. Joiirn., vol. v., p. 51) to be 4337
men, and 2853 women ; and the causes have
been thus assigned :

Cause!!. Men Women.

Poverty 905 511

Domestic grief 728 524

Reverses of fortune 322 283

Uruukeuness and misconduct .... 2tJ7 208

Ganibliii? 155 141

Dishonour and calumny 125 95

Disappointed ambition 122 410

Grief from love 97 157

Envy and jealousy 94 53

Wounded self-love 53 53

Remorse 49 37

Fanatici.sm Ifi 1

Misanthropy 3 3

Cases unknown • . . 1381 377

According to M. Falret, of 6782 suicides com-
mitted between 1797 and 1823, 254 were from
disappointed love, 157 being in women; 92
from jealousy; 125 from the chagrin caused
by calumny ; 49 from a desire, without the
power, of vindicating character ; 122 from dis-
appointed ambition ; 322 from reverse of for-
tune ; 16 from wounded vanity ; 155 from gam-
bling ; 287 from crime and remorse ; 728 from
domestic distress ; 905 from poverty ; 16 from
fanaticism. Upon comparing this table with
the preceding, very great inaccuracy will be ap-
parent, proving tiie very little dependance to be
placed upon numbers in medical details. Of
500 suicides committed in Berlin during six
years and a half. Dr. Caspar states that 14
were caused by offended honour ; 61 by insan-
ity ; 54 by drunkenness and dissipation ; 32 by
dread of punishment ; 18 by debt and domestic
trouble ; 12 by love ; 11 by matrimonial strife;
3 by disgust of life ; 12 by disease and pain ; 1
by religious excitement ; and 282 by causes
which were not specified.

608. C. The modes selected of quitting life
may be briefly noticed. These, in many in-
stances, have some reference to the occupation
or profession of the suicide. Thus, military
and naval men shoot themselves ; chemists and
medical men poison themselves, chiefly with
prussic acid ; barbers and hair-dressers cut
their throats ; shoemakers stab themselves,
&c. Fire-arms and sharp instruments, partic-
ularly pistols, razors, knives, and daggers, are
most frequently employed by men. Drowning,
hanging, poison, and precipitation from win-
dows or great heights, are the means of self-
murder most commonly resorted to by women.
In France, asphyxy, by the vapour of burning
charcoal, is often selected by females, and even
by males, particularly in cases of associated
suicide. Hanging, drowning, and poison are,
however, the means most frequently resorted
to by both sexes. The choice thus made does
not always depend upon what may be supposed
to cause the easiest or the most rapid death ;
but, probably, upon that mode which ofl"crs the
greatest facility, or is the most readily carried
into effect in moments of irritation, distraction,
or depression. It is remarked that a very large
proportion of suicides by drowning in London
are committed by persons residing in the vicin-
ity of the river and of the Regent's Canal.

609. Dr. Caspar states tiiat of the 525 cases
of suicide already noticed, 234 were committed
by hanging ; 163 by shooting ; 60 by drowning ;

648

INSANITY— SUICIDAL— Arrangement of the Causes op.

17 by cutting their throats ; 20 by stabbing ; 19
by tlirowing tliemselvcs from windows ; 10 by
poison ; 2 by opening an artery. M. Ei^quirol
gives the following details of 205 cases of sui-
cide in females: 49 by banging and strangula-
tion ; 45 by precipitation from windows, &o. ;
2 by fire-arms; 18 by sharp instruments ; 7 by
poison;* 5 by asphyxy ; 48 by starvation; 31
by drowning.

[In 1840, 10,881 cases of violent deaths and
suicides were reported in England and Wales
{Rcgtslar General's Report), of which 900 were
cases of suicide, and 65 were murders. t If we
take the instrument or means of death employ-
ed by suicides, the following will be the order
of their frequency : hanging, strangling, and
suffocation, 381; poisons, 161; wounds, 129;
drowning, 107 ; gun-shot wounds, 45 ; leaps
from heights, 18 ; unascertained, 60. Of the
cases of suicide by poison, 26 were by arsenic ;
19 by opium; 3 by oxalic acid; and 113 by
other poisons. During the year 1844, 184 cases
of suicide were published in the Journal of Com-
merce of this city, as having occurred in differ-
ent parts of the United States ; of which 154
were men, and 30 women — the ages ranging
from 16 to 81. The largest number occurred in
the month of July — 26. The quarter commen-
cing with July numbered 56; that commencing
with April, 48 ; October, 36 ; January, 32. They
■were distributed through the different states of
the Union in very unequal proportions; New-
York having furnished 44 ; Pennsylvania, 25 ;
Massachusetts, 20 ; Louisiana, 13 ; Maine, 9,
&c. In 29 cases, mental derangement was as-
signed as the cause ; in 9, habitual intemper-
ance ; in 12, depression of mind ; in 4, domes-
tic trouble ; in 3, Millerism ; in 3, dissipation ;
weariness of life, jealousy, and remorse, each
2 ;. while dyspepsia, ill-health, seduction, infi-
delity of wife, murder of neighbour, delirium
tremens, apprehended insanity, fever, dread of
death, want of employment, poverty, violent
passion, love, disappointed love, unlawful love,
gambling, orphanage, each, is assigned as the
cause of one case of suicide. In 101 cases no
cause was assigned. In 64 cases, suicide was
committed by hanging (54 men, 10 women) ; in
26, by drowning (17 men, 9 women) ; in 26. by
shooting with gun or pistol (all men) ; in 25, by
cutting the throat (24 men, 1 woman) ; in 8, by
taking laudanum ; in 5, by opium ; 1, morphine ;
2, narcotic poisons ; stabbing with poisoned sti-
letto, 1 ; by arsenic, 4 ; prussic acid, 1 ; corro-
sive sublimate, 1 ; opening an artery, 2 ; by
cutting the arm nearly off, 1 ; by jumping from
height, 1 ; by wounds and exposure, 1 : total,
142 men, 29 women : 15 were foreigners, the
rest Americans : 89 were married ; 32 single ;
1 widow ; 1 widower ; the remainder not stated.

No accurate estimate, however, can be made
from these data as to the number of suicides

* The small number of suicides by poison, in the tables
furnished by Caspar and Esq UIROI., deserves remark. On
the Continent, it is very difficult to procure poisonous sub-
stances unless by means of a physician's prescription. In
this country, a child or any wretch may procure them for
purposes of murder or suicide, without any difliculiy and
at the lowest prices, at all the shops, with very vew excep-
tions, where drugs and medicines are vended.

+ [There were registered in Kr.gland and Wales, in the
year 1842, 118,825 marriages, 517,739 births, and .149,519
deaths, lieing an excess of births over deaths (jf 168,220, the
averaije mortality being 1 in 45 ; in France it is 1 in 42; in
Prussia, 1 in 38 ; in Austria, 1 in 33 ; and in Russia, 1 iu 28.J

committed throughout our country, or in any
particular portion of it, as a large majority, it
is presumed, are never published. Besides,
those found dead and drowned are not included
among suicides, and yet we know that drown-
ing is one of the most common modes of ter-
minating life in the suicidal. The annual num-
ber of suicides in the city of New-York for the
last 38 years, according to the Reports of tJ-e
City Inspectors, is as follows : J'

In 1805
1806
1807
1808
1809
1810
1811
1812
1813
1814
1815
1816
1817

In 1818
1819
1820
1821
1822
1823
1824
18-25
1826
1827
1828
1829
1830

. 24
. 27
. 15
. 16
. 13
. 18
. 19
. 14
. 29
. 23
. 22
. 33
. 29

In 1831
1832
1833
1834
1835
1836
1837
1838
1839
1840
1841
1842-
1843

. 23
. '!9
. 30
. 33
. 29
. 33
. 42
. 43
. 45
. 28
. 39
. 33
. 19

These, however, constitute, it is believed, but
a part of the actual number of suicides com-
mitted, as many reported under other heads,
as "sudden," "accidental," "apoplexy," "un-
known," &c., doubtless belonged to this class.
The population of the city was, in 1805, 75,770;
in 1810,96,373; in 1815, 100,619; in 1820, 123,-
706; in 182.5, 166,086; in 1830, 197,112; in
1835, 270,089; in 1840, 312,852.]

610. ii. Arrangement OF THE Causes OF Sff-
iciDF,. — A. Circumstances pcdisposing to this Act.
— Hereditary predisposition ; the melancholic,
bilious, and irritable temperaments ; the mid-
dle period of life ; the male sex ; the unmarried
state ; indulgent and injudicious education,
without reference to moral and religious prin-
ciples ; masturbation and sexual excesses ;
drunkenness ; immoral amusements and exhi-
bitions ; the perusal of loose productions, and
of criminal and suicidal details ; idleness and
indolence ; habitual recourse to powerful men-
tal excitement ; infidelity, or a disbelief of a
future state of rewards and punishments ; states
of the air. or of the season, or weather, occa-
sioning depression of the nervous energy.

611. B. Circumstances exciting this Act, or
occasional exciting Causes. — a. Direct occasional
Causes. — The passions and feelings, particular-
ly love, conjugal affection, jealousy, ambition,
humiliated pride, sentiments of dishonour, loss
of female virtue, feelings of shame, violent an-
ger, fear, terror, and remorse ; gambling, ei-
ther from want, or a desire of strong emotion
and excitement, or covetousness ; imitation, or
mental infection ; fascination on looking down
from precipices ; chagrin, desperation, or dis-
traction ; reverses of fortune ; disappointments,
domestic unhappiness, and family dissensions;
the several forms of moral and partial insanity,
especially melancholia and religious insanity ;
the different' states of general insanity, par-
ticularly niania and puerperal insanity ; and
the delirium consequent upon numerous physi-
cal maladies.

612. b. Indirect occasional Causes. — Bodily
diseases of various kinds ; violent pain, and
incurable maladies ; the abuse of intoxicating
liquors, of opium, of mercury ; distaste of life
connected with the change of life in females,
and the loss of attractions from smallpox,
&,c. ; ennui, or tffidinm vita3, consequent upon
an effeminate and indolent state of existence.

INSANITY, SUICIDAL— Patholoqv of.

649

or a state of mind in which the passions are
without an ol)jeot to excite interest, or are in-
capable of being roused to feel an interest ;
want, and its attendant miseries ; anticipated
exposure or punishment ; motives of revenge.

613. c. General Causes. — Governments which
furnish numerous examples of violent deaths
in the execution of their laws, or which pos-
sess a sanguinary penal code ; the military
spirit, and military governments ; republican
and democratic constitutions ; political com-
motions, revolutions, and catastrophes, espe-
cially at their breaking out, or after the state
of excitation and turbulence has passed away ;
religious fanaticism, and, still more, the want
of religion ; superstitious doctrines ; unsound
religious and philosophical opinions ; depraved
states of society, of manners, and customs.

614. C. Causes 7nnsC injluenlial in Ihis and
other Free and Commercial Countries. — The
range given to the social passions ; the haz-
ards and losses in mercantile speculations in
the funds, and in joint-stock speculations and
companies, and the consequent ruin and de-
basement of families ; habits of dissipaticm ;
the indolence and ennui consequent upon wealth
and sated enjoyment ; the importance attach-

' ed to public opinion, and the instability of that
opinion ; the violent shocks and collisions of
opposing parties ; the inactivity to which mili-
tary and naval persons arc reduced during
times of peace ; the enthusiasm of religious
and philosophical sects ; the immorality of the
literature and scenic representations of the
age ; and the details of crime and of suicide,
which constitute a principal part of the daily
reading of all classes of the community.

615. iii. Pathology. — The Lesions observed iti
Suicides upon Dissection. — These, in many ca-
ses, will necessarily be the same as have been
already described in cases of manifest or fully-
developed insanity. In many instances the le-
sions will have no reference to the production
of this act, and in some they will be merely
the consequences of previous disease, which
had nothing to do with the subsequent occur-
rence of a suicidal impulse. The physical dis-
ease may have, in some cases, predisposed to
the indulgence of a suicidal intention, by weak-
ening the vital manifestations, and particular-
ly the powers of mind ; but, even in such ca-
ses, the mental emotion is to be looked upon as
the efficient cause of the act. Without, how-
ever, attaching much importance to the influ-
ence of the structural alterations in producing
it, as far as they have been yet investigated,
unless when it is unequivocally dependant upon
insanity, I shall briefly state those which have
been most frequently noticed. Heister ob-
served lesions of the liver, gall-bladder, and
pancreas. Fai.ket considers alterations of the
liver to be rare ; M. Esquirol remarked dis-
placement of the colon ; O.siander, congestion
of the vessels of the brain, and chronic inflam-
mation of the intestines ; Corvisart, Ai.berti,
and OsiANDER, fliseases of the heart ; Gkeding
and Gai.l, thickening and condensation of the
cranial bones : Home, dilatation of the sinuses
of the dura mater, and effusion of serum in the
ventricles, and between the membranes ; Ke-
camier and others, thit^kening of the araciinoid
and dura mater, with ossific depositions in thi^
latter; Falret and Fovii.le, traces of vascu-

lar irritation and excitement in the membranes
and substance of the brain ; and Frank and
EsQLUROL have failed, in many instances, to
detect any appreciable lesion of aay organ.
From 1333 inspections of suicides, the follow-
ing results have been given, but with little ap-
pearance of precision or accuracy : 'I'hicken-
ing of the cranial bones in 150 ; bony excres-
cences from their inner surface in 50 ; disease
of the membranes of the brain in 170 ; inflam-
matory appearances of the brain in 90; simple
congestion of the brain in 300 ; tumors in the
brain in 10 ; softening of the brain in 100 ;
disease of the lungs in 100 ; lesions of the heart
in 10 ; disease of the stomach in 100 ; altera-
tions of the liver in 80 ; lesions of the intes-
tines in 50 ; suppression of the natural secre-
tions in 15 ; syphilitic disease in 8 ; and no
apparent structural change in 100. (See ^ 223,
et seq.)

616. B. Physiological Pathology. — Suicide may
be viewed, in many cases, even when proceed-
ing from passion and feeling, as the result of
deranged action of the vessels of the encepba-
lon and of its membranes, consequent upon al-
tered sensation or excited emotion ; but it can-
not be considered as essentially and exclusive-
ly depending upon this pathological cause. The
intellectual and moral phenomena, which ei-
ther directly or indirectly give rise to the sui-
cidal determination, cannot be shown to be al-
ways the consequence of vascular lesion, or
even of excited vascular action, although they
often lead to such lesion, from the intimate
connexion existing between the mental mani-
festations and the organic actions. The nu-
merous instances in which suicide is attempted,
from ebullitions of temper, or gusts of passion
or feeling, and in which the means of self-de-
struction fail of accomplishing the intended
end, leaving those who made the attempt calm,
resigned, and happy at having failed in their
intentions, fully prove the absence of estab-
lished vascular lesion, and show the remark-
able difference between these and cases de-
pending upon real and confirmed insanity, which
we never find so immediately and permanently
cured as those instances of attempted suicide
fortunately are, and cured by the same means
as so generally fail in every form of suicide
proceeding from manifest insanity, wherein it
may be presumed that lesion of vascular ac-
tion in the encephalon, as well as of organic
nervous power, actually exists. We are there-
fore obliged to conclude that mental power
may be, hereditarily or originally, or from the
influence of the predisposing causes of suicide,
so weak, or so morbidly impressible or suscep-
tible, as to give way to the impulses to this
act, arising out of any of its exciting causes,
either before the controlling powers of mind
have had time to react and to resist the suici-
dal impulse, or from the circumstance of those
powers having been so weakened as to be in-
capable of sufficiently resisting this impulse
when excited by powerful or by combined caus-
es. In these cases, this act is to be imputed
to the state of mental energy — to a constitu-
tion of the mind arising out of hereditary con-
formation, and the prolonged operation of pre-
disposing circumstances, rather than to any
appreciable disorder of the cerebral circulation.

617. On the other hand, it ought to be ad-

INSANITY, SUICIDAL— Pathology of.

mitted, that incessant application to study, to
business, to political events, to the views and
interests of parties and sects, to the discharge
of pul)lic duties, or to the support of public
measures, as well as many of the numerous
causes above specified, will so far overturn
the equilibrium of the circulation as to occasion
an erethism of the vessels of the brain and its
membranes, verging upon inflammation, if not
actually amounting to it. Such a condition of
this organ may betray itself by a slight deliri-
um, or partial or slight form of mental aliena-
tion, by general irritation or nervousness, or by
slight fever, or by burning headache, with lit-
tle other disturbance of the system ; or it may
evince itself by a peculiarity of manner, by the
unusual direction of ideas, or by the state of
temper and feelings. If, during this condition
of disorder, the ideas should be led to self-de-
struction, or if any circumstance, whether do-
mestic or public, should occur, which, by exci-
ting the temper or affections, may suddenly in-
crease the cerebral disorder, as well as the
consequent morbid ideas or resolution, suicide
may be attempted ; or if, either after or before
the ideas prompting to this act have suggested
themselves, the individual should be placed in
a state of comparative inactivity, and his ideas
be allowed to flow in a direction most likely to
suggest or to confirm the resolution to resort to
self-murder, the event, although more mature-
ly contemplated, may not be the less certainly
accomplished.

618. Suicide, viewed in this direction — the
only one in which it can be considered with
propriety as a physical disease— may be at-
tempted by the strongest and most accomplish-
ed minds, although much less frequently than
by others educated without just principles, and
undisciplined in the school of difficulty, disap-
pointment, and misfortune. It is, under these
circumstances, like other mental alienations,
the result of vascular disorder in an organ in-
timately connected with the intellectual and
moral manifestations. We cannot, therefore,
be surprised that persons subjected to the most
important and harassing duties, and underta-
kings, and anxieties, should suffer in that or-
gan which is the medium or instrument of
these distracting operations ; and that the con-
sequences resulting from them, both to the or-
gan itself, and to the faculties related to it,
should be exactly those which these causes are
most likely, both from theory and experience,
to produce.

[This subject derives great importance from
the fact that policies of life insurance are held
to be valid in cases where suicide has been
committed in .a state of insanity, but forfeited
if the act is done in an opposite mental con-
dition. The doctrine that suicide is always
the result of insanity must be abandoned as
altogether untenable ; and the same evidence
of mental unsoundness, in doubtful suicidal ca-
ses, should be required as would be necessary,
in a court of justice, to establish the validity of
a will. Suicides must be divided into two class-
es, founded upon the different causes or cir-
cumstances by which they are actuated : the
first, including those who have committed the
act from the force of moral motives alone ;
the second, those who have been affected with
some pathological condition of the brain, exci-

ted or not by moral motives. The act itself,
apart from the circumstances under which it is
done, should never be quoted as positive proof
of insanity; although we believe that the ca-
ses are few in regard to which it would be safe
to affirm that the excitement of the organic
action of the brain and nervous system, which
accompanies the perturbation of mind leading
to the act, had not transcended the limits of
health, and passed into real pathological irrita-
tion. What renders the question a difficult
and very complicated one, is the admitted fact,
that suicide is often committed under the im-
pulse of mental derangement, even when men-
tal derangement would not otherwise have
been suspected. But this subject will be dis-
cussed in the ensuing section. (See "A Trea-
tise on the Medical Jurisprudence of Insanity," by
J. .Ray, M.D., 2d ed., 1844.)]

619. G. Is there a Suicidal Monomania ? — M.
Andral remarks, " that man is sometimes pos-
sessed by a sentiment which tends to self-de-
struction This feeling is designated ' Suicidal
Monomania.' It is not always the result of
mental alienation : some persons put an end to
their existence who are not monomaniacs," &c.
Now this is a contradiction, both in terms and
meaning, not very consistent with the reputa-
tion which this writer has obtained in this
country. After what has already been stated,
it will be evident that suicide is either the re-
sult of some form or other of general or partial
insanity, or of some state of excessive passion
or feeling which does not, in the usual accepta-
tion of the term, amount to insanity ; although
such passion or feeling may, at the moment, as
completely overpower reason and self-control
as any form of monomania. If moral insanity,
which I have described above as constituting a
form of partial insanity, be farther extended
than I have ventured upon, and, instead of be-
ing confined to those moral states of aberration
which either are slowly developed, or are per-
tinaciously entertained, or both, be made to
comprise those momentary states of excessive
passion or feeling which are suddenly excited
by intense moral causes, and which, in well-
regulated minds, soon subside, without any very
appreciable impairment of reason and self-
control, but which, in impressible minds unac-
customed to control, to disappointments, to
losses, and distraction, often give occasion to
insanity or suicide — then those cases of this
act that thus originate, and that seem the least
of all dependant upon insanity, may be consid-
ered as actually the result of the insane state ;
and to these the term suicidal monomania, or
any other equally expressive of the insane con-
dition, may be applied. But if we thus extend
the meaning of moral insanity, we must stretch
it still farther, and make it comprise, also, every
act of passion or anger, even the act of just
indignation roused by insult ; especially when
insult is repelled by a retributive blow which
may endanger the life of the aggressor. It
may be granted that, in a few cases, suicide is
the first symptom of insanity, the patient hav-
ing been previously undisordered in mind. But
this is an assumption rarely admitting of proof,
unless where the act has been attempted only,
and not carried into effect, other insane acts
being afterward committed. M. Andral, as
just noticed, admits that persons destroy them-

INSANITY, SUICIDAL— Prognosis.

651

selves as the result of other circumstances
than the want of reason ; and yet he terms
suicide thus occasioned a form of partial in-
sanity, and designates it " suicidal monomania."
Self-murder may depend on many grades of in-
sanity, and may, as I have shown, be the con-
sequence of the several forms of moral insan-
ity ; but when no degree of this malady is man-
ifest beyond this act, it would be more correct
to view it as tlie consequence of intense pas-
sion or feeling — the impulse to self-destruction
arising out of these emotions overpowering,
for the moment, the dictates of reason and the
control of the judgment. According to this
view, the term here used may still be said to
be appropriate ; and it may be allowed to be so,
if the word insanity be extended to the utmost,
so as to comprise the momentary impulses of
passion, feeling, and mental depression. Sui-
cide committed, or even attempted, in such cir-
cumstances, may then be viewed as a proof of
insanity, or be considered as a form of moral
insanity, or, as M. Andr.^i- has done, with va-
rious contradictions of himself, as a monoma-
nia — the aberration of mind consisting only of
the impulse to self-destruction. If, on the oth-
er hand, insanity is to be viewed in a less com-
prehensive sense — if it is not to be extended to
those momentary impulses of excited or de-
pressed passion and feeling which lead to acts
of violence against others or ourselves, and
which only for a time overpower reason and
judgment — then suicide, committed or attempt-
ed in the circumstances referred to, cannot be
justly viewed in the above light, but should be
looked upon as an act of passion, that, like
other violent acts, cannot, consistently with
good morals, or even with the safety of soci-
ety, be treated as an insane act. In the forms
of moral insanity noticed above (^ 69, et seq.),
it has been shown that, in addition to its more
or less gradual development, the moral aberra-
tion is generally pertinaciously adhered to ; and
that, when suicide follows, the connexion of
this act with such aberration, and with impair-
ment of the mental powers, is very obvious :
but where disorder of the moral manifestations,
or of the judgment, is not apparent, suicide be-
ing attempted, from a desire to escape the pun-
ishment of crime, or from humiliations of any
kind, or from intense passion, distraction, or
depression suddenly excited — from some mor-
al shock, the dependance of this act upon a
state of mind actually insane is not so mani-
fest ; and it will be to the benefit of the com-
munity not to consider it, in such circumstan-
ces, as the result of insanity. Numerous in-
stances have been recorded of persons who
have had recourse to suicide from imitation or
fascination — from the mental infection caused
by the self-njurder of some one, however little
noted for station or character. In such cases,
a predisposition to this crime may have already
existed, or circumstances may have occurred
to favour the suggestion of ideas of self-de-
struction ; the suicidal disposition being con-
firmed or determined by perusing the details of
this act, generally so lavishly furnished by the
daily and weekly prints. In some of those oc-
casions of imitative or epidemic suicide, the
moral infection has been arrested by inflicting
unusual indignities on the bodies of those who
perpetrated the crime ; thereby showing that

this act was not, as respected many of the ca-
ses which occurred in these circumstances, al-
together the result of the absence of reason, or
that the persons who had committed it could
not be accounted irresponsible agents.

[Dr. ll.w remarks, that when a person in good
health, and surrounded with everything that can
make life dear to him, deliberately destroys
himself without any visible cause, no balancing
of motives or scrutiny of private circumstan-
ces can satisfactorily explain it, and we are
obliged to consider it as a form of partial mor-
al mania. Where a person labours under a sui-
cidal monomania, we believe it may he gener-
ally recognised by other signs ; as deep melan-
choly, eccentricity of conduct, &c. Most of
these individuals labour under a constant de-
jection of spirits, presaging nothing but evil ;
imagining that they have committed some hei-
nous offence ; that their friends have forsaken
them, and are watching their movements ; that
they are hated and despised by the world ; they
complain of neglect ; become morose and taci-
turn ; utter bitter complaints ; weep ; say they
have committed the unpardonable sin ; that
their danmation is inevitable, &c. More or less
bodily derangement is usually present in these
cases, as a weak and irritable nervous system,
quickened circulation, imperfect digestion, and
especially derangement of the hepatic function.
After this state has continued for some time,
the mental derangement becomes more promi-
nent, and the wretched victim begins to see
visions, and to hear strange voices, and believes
that he has communications from superior be-
ings. All this time the idea of self-destruction
is frequently, if not constantly, before the mind,
and unless the patient be narrowly watched, he
will finally succeed, after various attempts, in
accomplishing his purpose. — Ray.]

620. iv. Prognosis. — The suicidal determi-
nation is generally removed with difficulty ; and
more especially when it is consequent upon any
of the forms of moral and partial insanity, or
is connected with chronic mania. In the ad-
vanced stages of melancholia particularly, as
well as in several other states of both partial
and general alienation of mind, the determina-
tion to commit suicide may he concealed, fre-
quently in so artful a manner as to lull the sus-
picions of the most careful attendants ; but it
is never removed, unless the mental disorder,
of which it is the associate, be altogether cured ;
and even m this latter case, the incipient re-
turn of insanity, or even the occurrence of
some of the symptoms usually preceding its re-
turn, m^y be attended by the suicidal attempt.
When suicide, however, is the consequence of
violent passion and feeling — of some shock
which the mind is incapable of enduring at
the time — when it proceeds from temporary
causes, and more especially where the attempt
has been made when the mind has been sub-
jected to the first impression of the direct occa-
sional causes (i^6ll), and when the predisposing
causes are not powerful, nor retain their influ-
ence in the mind — then well-grounded hopes
of the removal of an inclination to suicide may
be entertained. When this act has been at-
tempted from causes favouring an unusual de-
termination of blood to the head, or erethysm
of the capillary circulation of the brain, as vio-
lent mental excitement, controversy, distrac-

653

II^SAl^ITY, SUICIDAL— Treatment of.

tioh, or intense rnental exertion, the violent
sliocks.of revolution, or the collision of oppo-
sing, parties, &c. — then an appropriate physi-
cal treatment, especially that directed to the
removal of. increased action in the brain, and
of inteVfupt.ed secretion and excretion, will gen-
erally,- also, remove every disposition to a repe-
tition oRUie" attempt ; unless, indeed, similar
exciting .causes again come in operation. In
all cases of attempted suicide from powerful
passion or feelings, the possibility of some form
of insanity, particularly melancholia and mania,
being soon afterward developed, should be anti-
cipated, and the more especially if mental disor-
der or a suicidal propensity has appeared in any
of the members of the patient's family. In fami-
lies thus circumstanced, the suicidal attempt is
sometimes the first manifestation of insanity.

621. V. Tke.^tment. — The treatment of a
suicidal disposition in most cases, and espe-
cially in those which are connected with the
more obvious manifestations of partial or gen-
eral insanity, is to be conducted on nearly the
same principles as have been explained with
reference to these states of disease. In such
cases, the suicidal determination is only a part
of the disorder, requiring the increased care
of the attendants, and greater caution on the
part of the medical advisers, particularly during
apparent convalescence and recovery, and the
strictest precautions against a return of the
malady, and upon the appearance of symptoms
usually preceding this occurrence ; but in other
respects demanding little or no modification of
the physical and moral means of cure already
advised for the several forms of mental dis-
ease. The few observations, therefore, which
it will be necessary to offer on the treatment
of the suicidal impulse or disposition, may be
divided into those which refer, 1st, to the
careful removal of the circumstances which
suggested or occasioned it ; 2dly, to the phys-
ical means which should be resorted to ; and,
3dly, to the preservative measures or means of
repression, moral and legislative, which may be
instituted.

622. A. The avoidance or removal of the cir-
cumstances or causes which suggested or occa-
sioned the suicidal attempt is the basis on
which both physical and moral means of cure
must necessarily be placed. This end, however,
cannot always, or even generally, be attained ;
particularly where certain events have pro-
duced a powerful or morbid impression on the
patient's mind, or where the attempt has pro-
ceeded from an insane delusion. Under the
former circumstances, we can only endeavour
to counteract or to weaken the emotion pro-
duced : in the latter case the delusion will dis-
appear only upon the removal of the mental
disease. A knowledge of the several occasions
of the suicidal determination will sometimes
enable the physician to recommend means to
neutralize their injurious influence, even when
he finds that the patient is incapable of escaping
from their banelul influence on his mind.

623. B. Tiie physical means of cure should be
directed chiefly with reference to the symptoms
indicating the condition of the circulation in
the brain, and the state of organic nervous
power. These symptoms should be carefully
investigated and considered in connexion with
the phenomena more intimately connected with

the suicidal impulse, and with mental disorder.
If the impulse has followed any of the states of
moral insanity, or melancholia, or other forms
of alienation, the treatment, physical and mor-
al, is altogether the same as already described ;
stricter precautions during the treatment, and
upon the restoration of the patient to society,
being requisite. In many of these cases, par-
ticularly those depending upon melancholia, and
where the suicidal determination has appeared
in consequence of the circumstances which
have been shown generally to occasion in-
creased action of the cerebral vessels, and of
violent passion, chagrin, or distraction, general
or local vascular depletion, purgatives, refriger-
ants, and derivatives are requisite. The pain,
tension, or constriction, and uneasiness so fre-
quently experienced in the head ; the disorder-
ed action of the carotids and cerebral vessels,
and the appearance of the eyes ; the tempera-
ture of the scalp, and the changes frequently
observed after death — all evince the propriety
of repeated blood-lettings, especially in the im-
mediate vicinity of the brain, or of the ha^mor-
rhoidal vessels.* Cold affusions on the head,
cold applications, the shower bath, purgatives
conjoined with sedatives and repressants, re-
frigerants with diaphoretics, occasionally pow-
erful or deobstruent cathartics, and sometimes
emetics, anodynes with antispasmodics, dry
cupping, setons, blisters, or other derivative
applications on the nape of the neck, or on the
hypochondria, and, after depletions and deob-
struent evacuants, restoratives and tonics —
constitute, in such cases, the chief physical
means of cure ; but they require to be varied
appropriately to the peculiarities of individual
cases, and to be aided by hygienic and moral
measures, according to the circumstances or
motives occasioning the suicidal attempt, and
the form of insanity of which it may have been
a manifestation. In most instances, however,
exercise in the open air, manual and mental oc-
cupations, travelling, active amusements, hunt-
ing and horseback exercise, visiting watering
places, &,c., living in a dry and equable atmo-
sphere, change of air and of scene, and the mor-
al influences {(^ 500, et sea.) already fully de-
scribed, should be brought in aid of the more
strictly medical agents.

624. .\fter vascular depletions, where they
are indicated, emetics, even a repetition of
them, are often of great service, where the
suicidal propensity has recently appeared ; and
if much biliary disorder is present, a dose of
calomel, followed by stomachic purgatives, and
subsequently by restoratives and antispasmodics,
as the preparations of valerian, will often be
useful. Warm bathing, and cold sponging the
head during the bath, or the cold affusion on the
head, and the shower hath every morning, the
feet being immersed in warm water, are also
important, and generally appropriate remedies.
The suicidal determination is very frequently
associated with, and sometimes the conse-
quence of prolonged sleeplessness, arising from
the remote causes of the mental affection. In

* [That attempts at suicide arc often occasioned by a
fulness of the cerebral vessels, is evident from the fact that
the loss of blood orcasioned by an ineffectual attempt lo sev-
er the large vessels of the neck has effectually removed the
projiensiiy to destroy life; the same effect, also, has fre-
quently followed a plunge iuto colu water for the purpos«
of drowning.]

INSANITY, SUICIDAL— Teeatment 6f.

653.

these cases, a recourse to narcotics becomes
requisite ; the selection and combination of
them, as well as the particular indications con-
nected with the use of them, being guided by
the principles already explained (^475, ct scq.).
625. Cs Surveillance and Restraint. — When-
ever a suicidal propensity appears, the disease
should !)c treated, as respects seclusion and
control, in every respect as above recommended
(^ 388, et seq.), and the patient be placed in the
charge of an experienced and vigilant attend-
ant. Care should be taken to remove from his
person and apartment every article by means
of which he may carry his design into execu-
tion, and the windows, doors, &c., should be
secured. Even the bed-clothes should be care-
fully examined, lest portions of them should be
torn off for the purpose of self-strangulation.
Although melancholic and other insane persons
are not so likely to attempt suicide when others
are present as when alone, yet the former cir-
cumstance is not always sufficient to deier
them from it. Dr. Burrows adduces an in-
stance in which a medical man, while another
person was present, attempted to open the fem-
oral artery with a penknife. His father and
grandfather had both destroyed themselves.
He had never met with any circumstance to
occasion him particular disquietude ; but at the
age of forty-five he became dyspeptic, low-spir-
ited, and listless. He expressed extreme sor-
row for the attempt on his life ; yet, in three
or four days, he seized a razor from the dress-
ing-table, while his keeper's back was turned,
and at one stroke divided one of the carotid
arteries.

626. A person who has once entertained a
suicidal propensity should not be confided in,
however strongly he may express his regrets
at having made an attempt to carry it into ef-
fect, as long as the feelings continue either
more than usually blunted or morbidly sensi-
tive — while the bearing of the patient contin-
ues embarrassed or perturbed, or his ideas con-
fused, unsettled, or disturbed. If he complain
of heats and flushings in various parts of his
body, or partial sweats ; and especially if his
nights are sleepless ; if he cannot look the per-
son whom he addresses fully in the face, with
a firm expression ; and if his eyes betray timid-
ity, fearfulness, distrust, and restlessness, oth-
er attempts will be made. Although the pa-
tient may have recovered his serenity of mind,
a return of these indications ought to call for
the most watchful solicitude from the medical
and other attendants ; for, although the patient
may not seem to entertain any ideas of suicide,
or may actually not feel any inclination to com-
mit the act, yet the occurrence of an opportu-
nity, or the accidental sight of an instrument
of self-destruction, may give rise to the im-
pulse, which may instantly be carried into fatal
eflect.

627. Whenever a great calamity lias overta-
ken a person of weak resolution, of the melan-
cholic, nervous, or irritable temperament, and
especially if insanity or suicide have occurred
in any branch of his family— particularly if the
affliction is sudden or recent, and productive
of great mental distress, or of singularity of
conduct or conversation — the probabdity of his
attempting suicide ought not to be overlooked.
The design, however, in these circumstances

maybe concealed from superficial " observers ;
but the physician will detect, in the exiJi-ession
of the cyes^ and looks, in the suppressed*sfrug-
gle to conceal his einotions, in the constrained
respiration, and the accelerated, psfcited; or .ir-
regular pulse, sufficient causesto Veqftife' the
utmost vigilance on the parts of both friends and
attendants. In such cases, the pre.vicfus char-
acter and fortitude of the patient may lull every
fear ; but the greatesftalents and the strongest
minds have yielded to intense emotion. The
moral character and disposition of the patient
may have been changed before the suicidal pro-
pensity was developed ; many of the circumstan-
ces to which this propensity had been directly
imputed actually occasioning a state of moral
or partial insanity, of which the suicidal inten-
tion was only an attendant or consequence.
Moreover, character and disposition only should
not afford any grounds of confidence in persons
subjected to the more intense emotions, or to
the more energetic occasions of this act ; more
especially if they have not formerly experien-
ced events requiring the exertion of mental en-
ergy and fortitude. Many men, eminent for tal-
ent and excellence of disposition, have commit-
ted suicide when overtaken by adversity. Sev-
eral instances of this kind occurred, during an
early part of the present century, in this coun-
try, and have been adduced by some writers
as proofs of the strongest minds being liable to
give way to the suicidal impulse. But emi-
nence and talent are distinct from fortitude in
adversity; and even from that constitution of
mind to which the terms strength of mind or
force of character have been applied. It is
doubtful how far these persons* were really
possessed of these latter characteristics, inas-
much as they are usually acquired in combat-
ing difficulties, in patiently bearing adversity
and disappointments, and in controlling the
more poignant emotions which difficulty and
adversity call forth. In this school, where true
force of character and fortitude are chiefly, if
not only to be acquired, these persons may not
have been sufficiently disciplined; for, when
the course of prosperity has been uninterrupted
and rapid, however eminent the abilities which
have contributed to it may have been, sudden
adversity may endanger the perfect sanity or
fortitude of a mind unaccustomed to sustain
and unprepared to meet its shock.

628. There is no part of a physician's duty
which is so difficult, as Dr. Burrows has re-
marked, as to decide upon the exact time when
he may place confidence in a convalescent sui-
cide. If this confidence be yielded premature-
ly, the act, whicii time and great care had been
employed to avert, may be immediately perpe-
trated ; while, if it be withheld when the pa-
tient feels that he has been labouring under a
delusion, the effect may be such as to endanger

* [The dislinjjuished accoucheur who attendee) the Prin-
cess Chaklotte in her fatal confinement destroyed him-
self under the sudden impulse of grief and niortifiration.
The sight of a pair of pistols in the room t^) which he
retired fi)r repose was sufficient, to a mind harassed by
long and nnxioiis attendance, and overwhelmed by the re-
spiinsibilities of his sitiialinn, to provoke a desire, which ho
may never have felt before, to die by his own hands. Sir
S.tMUEL RoMiLLy,thc eminent English barrister, commit-
ted suicide imincdiatcly aficr sustaining a severe domestic
bereavement — the loss of a beloved wife. In both these ca-
ses we should, perhujs, be warranted in believing that roft-
son was teniporaiily ovcrlhrovra. — (Ray.)]

654

INSANITY, SUICIDAL— Prevention op.

a return of his delusion, or of the suicidal pro-
pensity.

629. When the suicidal determination cannot
be carried into effect by any other means, ow-
ing to the care of the attendants, the patient
sometimes determines to starve himself. Man-
agement may do much in overcoming this in-
tention. Kind entreaties and stratagems may
be resorted to ; and tempting articles may be
set before him, or left within his reach, without
any farther notice. If he partake of it, no re-
mark should be made, but the same course pur-
sued. If these means fail, the stomach-pump
ought to be resorted to.

630. M. F.iLRET observes, that noisy or im-
moderate gayety irritates melancholic suicides,
or, at best, affords only a transient pleasure,
followed by increased misery. He states, that
he has accompanied these persons to the thea-
tre and to the hospitals^ in order to compare
the effects produced upon them by these oppo-
site spectacles ; and he has found that visits to
the really afflicted were most useful, by sug-
gesting the idea that others had still greater
cause than they of being unhappy.

631. D. Prevention and Repression. — The
increasing frequency of suicide, as well as of
manifest insanity, requires some notice of the
means by which it m.ay be, in some measure,
repressed, although no sanguine hopes of suc-
cess from them can rationally be entertained
in the present states of society. As long as
education, manners, morals, and social inter-
course continue as they now are ; as long as
crimes, murders, and suicides are seductively
detailed and daily furnished to the public,
through a thousand channels, for the purposes
of private gain ; as long as the perpetrators of
crimes and of homicides are held out, both on
the stage and from the press, as heroes of their
day ; as long as the overthrow of moral and
religious principles and the infection or con-
tamination of the public mind are made objects
of gainiul speculation, into which persons in
place or authority are not considered dishon-
oured by entering ; as long as the streams of
moral pollution are allowed to flow without ei-
ther strenuous, or well-directed, or combined
efforts to confine or to counteract them ; as
long as the most instant and efficient agents
of self-destruction are openly sold in every
street, at little or no price, and to any purcha-
ser, without either " let or hinderance ;" as long
as the struggles of great parties in politics and
religion absorb, in connexion with the details
of every vice and every crime, the public mind,
each party endeavouring to depress and ruin
the others, without regard to the general weal ;
as long as provision for the pecuniary wants
of the state, and the power and patronage of
office, constitute the chief objects of govern-
ments ; as long as justice is within the reach
only of the wealthy, as laws protect chiefly the
bad, as the weak are unshielded, and the de-
serving unrewarded ; as long as

" The whips and scorns of time.
The oppressor's wron^, the proud man's contumely.
The pangs of despised love, the law's delay,
Tho insolence of office, and the spurn.';
That patient merit of the unworthy takes,"

shall continue to " puzzle the will ;" as long
as the lives of all classes are endangered, and
their minds distracted by unprincipled and ig-

norant pretenders to medical and religious
knowledge, who are allowed, and even encour-
aged, to take advantage of the credulity and
fears of the weak-minded ; as long, in short, aa
moral degradation and physical destitution ex-
ist, and as long as the safety of the people is
not the supreme law of the state ; as long as
these several conditions of a country continue,
and in proportion to their separate and combi-
ned influence, so long will suicides be frequent,
or even increase.

[It is a generally admitted fact that suicides
are increasing to a most alarming extent in our
country. But few find their way into the pub-
lic prints, and yet our newspapers contain very
frequent instances of the kind. The causes are
to be sought for chiefly, we believe, in our de-
fective systems of education, separating moreil
and religious culture from intellectual studies,
and making the latter the great, if not sole ob-
ject of public and private teaching. The dis-
proportionate attention thus paid to the culti-
vation of the intellect destroys the healthy bal-
ance of the mind ; takes from it the support and
influence of those high and holier motives, feel-
ings, and aspirations, which support it under
trials and losses, soothe it in affliction ; which
moderate the whisperings of selfishness and
ambition, and enable us to await the events of
futurity with composure and resignation.

If the young were properly educated, "man-
ners, morals, and social intercourse'" would
take care of themselves ; they would necessa-
rily improve, and the other causes of suicide
maintained by our author, as theatrical shows
and a licentious press, would be comparatively
harmless. Indeed, in a healthy state of the
public mind and public morals, such streams
of moral corruption would be checked at their
very source. Hence we deem it the duty of
every patriot and every philanthropist to use
all possible exertions to reform our present
vicious system of public school education — the
fons et origo mali.}

633. The history of all nations has demon-
strated the prevalence of this act, both as a dis-
ease and as a psychological phenomenon, du-
ring periods of surpassing luxury, of criminal
debasement, of public commotion,* and of the
decline of public and private spirit and virtue.
In such circumstances, laws directed simply to
this act, and without reference to the sources
of the evil — to the various contaminating mor-
al agents poisoning the minds of the communi-
ty — will be of but little avail. It is obvious,
that laws which, as at present, affect only the
property of the suicide, are unjust, as they can-
not punish the guilty, but fall exclusively on
the innocent — on those already punished by the
act of the suicide. The only means oi preven-
tion which have been found to succeed, on oc-
casions of epidemic or imitative suicides, have
been such as tended to impress the ignorant
with the moral and religious turpitude of the
act, to influence public opinion in its reproba-
tion, and to convince the perpetrator of the
crime that, although he escapes from feeling

* In the summer of 1793, upward of 1300 suicides were
convmitted in Versailles and its vicinity! During "the
reign of terror," or, rather, of crime, suicides were commit-
ted hy the guilty, by the terrified, by infidels, and contem-
ners of moral and religious principles, by public and private
criminals, and by those distracted by losses of fortune and
friends, m unheard of numbers thioughuut France.

INSANITY AND SUICIDE— Bibliography and References.

656

the punishment it merits, every indignity which
is compatible with thr; good i>f society will, as
a consequence, be offered to his body, and to
his memory. Each member of the community
lives not for himself alone, but for the common
weal, and in order to contribute to the general,
the mutual, the public, and the private support
requisite to the healthful constitution of socie-
ty. As it is the chief purpose of good govern-
ment to preserve inviolate this principle of ex-
istence in all associated communities, so ought
every effort to contravene it, or to escape from
the responsibilities it involves, to be repressed
and punished in ways the most effectual, con-
formably with the spirit in which only should
punishment be inflicted ; and even those who
either directly or indirectly aid in the commis-
sion of this act should be subjected to punish-
ment. The difficulty, however, is to determine
upon measures which may have any influence
in diminishing the number of suicides, who are
either irresponsible agents, or are in that state
of mind which is uninfluenced by worldly con-
siderations. There is every reason to believe,
nevertheless, that many of those who commit
this act without being manifestly insane — who
entertain a suicidal propensity from depression
of spirits ; from mortified pride ; from domes-
tic chagrin or irritation ; from excessive pas-
sion or feeling ; from imitation, fascination, or
mental infection ; from extreme profligacy, de-
bauchery, and satiety, &c. — would be deterred
from it by the conviction that, if they perpetra-
ted this crime, some indignity to their bodies,
and disgrace to their memories, would be the
result. If it were enacted that the body of a
suicide, who had not evinced sufficient proof
of previous insanity to require restraint, or
whose relations had not seen sufficient proof
of mental disorder to obtain medical aid, or oth-
er assistance requisite to the protection of oth-
ers as well as of himself, should be made sub-
servient to medical instruction, and consequent-
ly to the general weal, I am confident that the
number of suicides would diminish, notwith-
standing the increased and increasing sources
of mental contamination, and of mental dis-
ease. Means of repression directed to the prop-
erty of a suicide would have little avail, and
would, moreover, punish the innocent without
affecting the guilty ; but such means ought to
be strenuously directed against those who deal
in poisonous substances, and ought to be ren-
dered so stringent as entirely to prevent such
substances from being procured unless by
means of a physician's or surgeon's order or
prescription. It is well known that suicide is
often committed in moments of irritation or
passion, and that as soon as the feeling sub-
sides — in the course even of a few minutes —
the suicidal impulse or intention may cease to
influence volition so powerfully as to lead to
the commission of the act. Therefore, if diffi-
culties were thrown in the way of resorting to
it, during periods of irritation and suicidal im-
pulse, it might not afterward be entertained, or
the sober mind would recoil with so great hor-
ror from the morbid idea, as to view it with in-
creased dislike, or would endeavour otherwise
to fortify or to protect itself against a return of
the propensity.

633. Having thrown out these hints as to the
only means of repression which can be suggest-

ed, after a consideration of those which have
been enacted in this and in foreign countries, I
would merely add, that the growing frequency
of suicide requires that means, direct and indi-
rect, should be taken by the Legislature to re-
strain it. As, however, many of the most in-
fluential causes of suicide can only be indirect-
ly affected by legislative measures, and as some
of these causes belong to the liberty enjoyed
by all classes, although appertaining chiefly to
the most worthless parts of that liberty, but lit-
tle hope can reasonably be entertained that the
frequency of this act will be much diminished,
as long, at least, as the circumstances arising
out of the education, morals, amusements, and
social relations of the community, to which it
is in great measure referrible, continue un-
changed.

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Med. Society, Feb., 1844, 8vo. — James Macdonald, Reports
of the " Bloomingdale Asylum," 1832 to 1841 ; also. Statis-
tics of the " Bloomingdale Asylum for the Insane," in the
New-York Journal of Med. and Surgery, vol. i., p. 307. —
Cases of Monomania, in New-York Journal of Med. and
Surgery, vol. iii., p. 307. — Charles Evans and J. H. Worth-
ington. Report of the " Friends Asylum for the Insane,"
near Philadelphia, 1844-5.— £tia7is and Porter, Reports of
Cases of Insan., in Am. Jour. Med. Sciences, vols, xix., xx.,
p. 99, 61, 350 ; vol. xxiii., p. 97.— F. T. SlribUng, Reports
of " Western Lunatic Asylum," Staunton, Va., 1844, 5, 6.
— Daniel H. Trezevant, Report of " South Carolina Asy-
lum for the Insane," 1835 to 1846. — David Cooper, First An-
nual Report of the Resident Physician of the "Lunatic,
Idiot, and Epileptic Asylum of the State of Georgia," 1845.

— Wm. M. Awl, Reports of the " Ohio Lunatic Asylum, at
Columbus," 1839-1846. — JoAn R. Allen, Rep. "Kentucky
Lunatic Asylum," Lexington, 1840-5. — William Fisher,
Rep. of "Maryland Insane Hospital," Baltimore, 1844. —
iS. G. Morton, Crania Americana, 78 Plates, 1 vol., fol.
Phil.— Crania jEgyptiaca, &c., 1 vol., 4to. Phil., 1844.—
D. Oliver, First Lines of Physiology, 2d ed., 8vo. Phil.,
1841. — J. A. Smith, Select Discourses on the Functions of
the Nervous System, &c., 12mo. New- York, 1840. — S.
Sally, The Human Brain, &c., 8vo. Lond., 1836.—/. Har-
rison, Essay towards a correct Theory of the Nervous Sys-
tem, 1 vol.,' 8vo. Phil., 1844.— R. W. Raskins, History and
Progress of Phrenology, 12mo. Buffalo, 1839.]

INTESTINE— Syn. 'Evrrpov (ab evtoc, intus)
— Intestinum (from intus, within). — Intcslin,
Boyeau,Yr. Darm, Ger. Intcsttno, Ital. — Bow-
el ; Gut ; Intestinal Canal ; Intestinal Tube.

1. Most of the disorders and structural dis-
eases to which the intestines, in general, are lia-
ble, are discussed in appropriate articles. The
seat and nature of these affections required a
separate consideration for them ; and, at this
place, it remains for me chiefly to supply what-
ever I may have omitted in these articles, and
to treat of those subjects which have not been
entered upon, under different and more appro-
priate heads.

2. It need hardly be stated that the intestines
comprise, or consist of the following parts, de-
scending from the stomach to the verge of the
anus, namely, the duodenum, the jejunum, the

ilium, the ccEcum, the colon, and the rectum. As
each of these portions of the intestinal canal
presents most important connexions with, and
relations to other viscera, that are not possess-
ed to an equal degree, or in a similar manner,
by the others ; as they are, in many respects,
and particularly as regards certain of their
functions, distinct organs ; and as they are oft-
en severally the seats of disorders, more or less
limited to either of them, so I have treated of
the diseases to which each of these portions of
the intestinal canal are most liable under their
respective heads. As there are certain mala-
dies which affect in some degree or other
more than one of these distinct portions of the
bowels, and which often implicate, or even ori-
ginate in some one or more of the collatitioua
viscera, and in which not only the intestines,
but the various related viscera, and even the
frame generally, frequently are also disordered,
although in different grades and forms, and to
a varied extent, according to numerous circum-
stances connected with the cause of the dis-
ease, and state and constitution of the individ-
ual attacked, so I have treated of these mala-
dies under the names commonly applied to
them, but with strict reference to their seats,
natures, and pathological relations. Thus,
while I have considered the diseases individu-
ally seated chiefly in either the duodenum, ca-
cum, colon, &c., under these heads respectively,
I have likewise discussed colic and ileus, cos-
tiveness and constipation, diarrhoea, cholera, dysen-
tery, gaslro-enteric disease, flatulency, intestinal
hemorrhage, i7itcstinal concretions, and icorms,
&c., in these several articles, because these
complaints are not limited, in their seats, to
one portion of the intestinal canal only, but oft-
en extend to several portions of it, although in
different grades, and frequently depend upon
disorder of the adjoining viscera, and some-
times even of distant organs, and of the system
in general. Moreover, as the organic lesions
which occur in the intestines are not peculiar
to any one portion, but extend, in different mal-
adies and persons, and in different degrees of
frequency and severity, to all of them, and even
also to the stomach and oesophagus — to the
whole digestive canal from the lips to the anus
— so I have considered these lesions under the
head "Digestive Canal," and have thereby
avoided the repetitions into which I should oth-
erwise have been betrayed. It here chiefly re-
mains for me to consider those maladies seat-
ed principally in the small and large intestines,
in the ileum, jejunum, and colon, that are not
discussed under different or more appropriate
heads. The functional disorders and the struc-
tural changes to which the intestines are liable
being fully treated of in the articles just men-
tioned, I now proceed to consider chiefly their
inflammatory diseases. In the article on the
peritoneum, however, much will be found more
or less intimately connected with inflammations
of both the small and large intestines, to which
sufficient reference will be also made in those
sections where inflammation extendmg to the
peritoneal coat of the bowels, and the compli-
cations of enteritis, are considered.

I. INFL.4MMATI0N OF THE SMALL INTESTINES,

SvN. Xo/)(5ai/;of, EiAeof, AretEBus, Galen. Fe-
bris intesiinorum inflammatoria, Hoffmann.
Intestinorum Inflammatio, Boerhaave. Enter-

INTESTINES— Inflammation of Small— Svmptoms.

659

itis, Sauvages, Vogcl, Sagar, Cullen, Pinel.
Emprcsma Enteritis, Good. Cauma Enteritis,
Young. Geddrmcntziindan^, EntzUndung der
Geddrme, E. der Barmen, Germ. Ent^rite,
Inflammation dcs Boyaux, Fr. Inflammazionc
d'lntestini, Ital. Inflammation of the Bowels.
Classif. — 1. Class, Febrile Diseases; 2.

Orrfer, Inflammations (Cm/^cw). 1. Class,

Diseases of the Sanguineous Function ;

2. Order, Inflammations (Good). III.

Class, I. Order {Author in Preface).

3. Dekin — Tenderness or pain of the more cen-
tral parts of the abdomen, increased on pressure,
generally with symptomatic fever, disordered def-
ecation, and frequently nausea and vomiting.

4. Inflammation generally commences in one
only of the constituent tissues of the small in-
testines, and frequently continues to be thus
limited during its course ; but it frequently,
also, extends to the other parts, until even all the
textures forming a portion of intestine are im-
plicated. Thus the glandular apparatus, or the
mucous membrane only, may be inflamed, and
the disease may not extend farther, although it
may exist long, or be extremely acute ; but it
often, also, invades the other tissues, more es-
pecially the connecting cellular tissue, until the
peritoneal coat is at last inflamed, and all the
phenomena of circumscribed or diffused peri-
tonitis are produced. When all the constituent
tissues of a portion of intestine are affected,
the inflammation usually has commenced and
proceeded in this manner ; for it is but seldom
that there is reason to infer that the inflamma-
tion has either simultaneously invaded all the
coats composing a portion of bowel, or has
proceeded in an opposite direction, namely,
from the peritoneal to the other coats ; unless,
indeed, in cases of external injury, or of stran-
gulated hernia, or when the inflammation has
extended from adjoining parts to the intestines.

5. Inflammation of the intestines, whether
limited to one only, or implicating two, or all
of their constituent tissues, may assume any
grade of intensity and acutencss, from the most
acute down to the slightest degree and the most
chronic form. It may appear, in either of these
states, as a simple or uncomplicated disease, or
associated with other maladies. In this latter
state, it may be either primary or idiopathic, or
consecutive or symptomatic. In each of the
above forms it will be here considered.

6. i. Inflammation of the Mucous Surface
OF the Intestines. — Muco-Enteritis of Arm-
strong. — Muci-Entirite, Enterite Villeuse, of
French pathologists. This complaint varies in
its characters with its intensity, and with the
temperament and habit of body of the patient :
a slighter grade of it often causing, in irritable,
nervous, and plethoric persons, more acute
symptoms than a severer degree in those who
are melancholic or leucophlegmatic. The symp-
toms, moreover, are farther varied by the ex-
tension of the inflammatory affection, in some
degree, to the duodenal or gastric villous sur-
face on the one hand, or to the internal surface
of the caecum and colon on the other ; for the
mucous coat of the small intestines is inflamed
more frequently in conjunction with one or
more of these than in an unassociated form;
and not infrequently some one of the adjoining
viscera is also more or less disordered. In-
deed, the enteric disease may be altogether

consecutive of, and caused by derangement of
one or other of these viscera. Thus, a discharge
of acrid or otherwise morbid bile into the duo-
denum may occasion or perpetuate inflamma-
tion of the mucous surface of the intestines,
and often, also, of the large bowels.

7. A. Symptoms. — a. In the acute or sub-acute
states of the complaint, the abdomen is usually
distended, sometimes tense, and flatulent. A
dull or heavy, deep-seated pain or soreness, oc-
casionally with a sense of heat, is felt upon firm
pressure, especially around the umbilicus, or
towards the right iliac region ; but this latter
symptom is often absent, and is more general-
ly found when the follicular glands are affected.
In the more acute cases, the abdominal parie-
tes are warmer than other parts of the body ;
and a feeling of internal heat of the bowels is
also often complained of, with colicky pains,
particularly after cold drinks, and the more
heating or indigestible articles of food. Mus-
cular power is much weakened, and the skin is
harsh and dry. There is more or less thirst ;
and the appetite is impaired or lost. In severe
cases, or when the disease is far advanced,
there is often nausea or vomiting ; this latter
symptom depending much upon the extension
of the affection to the internal surface of the
duodenum and stomach. The alvine evacua-
tions are generally morbid, sometimes too fre-
quent, at other times too rare and scanty ; but
usually preceded or attended by flatulence, bor-
borygmi, and the escape of much flatus. When
the internal surface of the large bowels is un-
affected, constipation is often present, but short
attacks of diarrhoea, occasionally alternating
with costiveness, frequently occur. The stools
frequently vary in colour and consistence with
the state of the biliary functions and the kind
of the ingesta : when there is diarrhoea, they
are generally pale, yeasty, and crude, or insuf-
ficiently digested ; when the bowels are costive,
they are often offensive, dark, and scybalous.
The urine is high-coloured and scanty, and often
deposites a copious sediment. The mouth is
clammy, with a bitter or unpleasant taste. The
tongue is white or yellowish in the centre, but
red at its point and edges. The pulse is accel-
erated, and generally small and soft when there
is diarrhoea, and full, or even hard, when the
bowels are confined.

8. In more intense or acute cases the fore-
going symptoms are more prominent. The ab-
dominal distention amounts almost to tympani-
tis ; the pulse is quick and constricted ; the
thirst is great ; the tongue is furred, loaded,
and dry ; the urine scanty and high-coloured,
and all the secretions and excretions diminish-
ed. Pain, soreness, internal heat, and tender-
ness of the abdomen are greatly increased, and
the surface is hot, dry, and harsh. The affec-
tion of the intestinal mucous surface extends
its influence to the cerebro-spinal system, caus-
ing sleeplessness, restlessness, and ultimately,
in the more unfavourable cases, delirium, start-
ings of the tendons, and in young persons and
children especially, convulsions and coma.
In many of these more severe attacks, partic-
ularly in the sanguineous temperament and
plethoric habits, and in warm climates or sea-
sons, the inflammatory affection of the mucous
surface rapidly extends to the external coats
of the part of the intestine chiefly diseased ;

660

INTESTINES— Inflammation of Small — Symptoms.

and the <orm of enteritis about to be noticed
(^ 30) supervenes.

9. Acute muco-enteritis commences variously
— sometimes slowly and insidiously, with im-
paired appetite, slight thirst, loaded or white
tongue, a slight sense of heat in the abdomen,
or colicky pains and slight disorder of the bow-
els. These symptoms, at first, are hardly ap-
preciable, but they become gradually more and
more severe, until the pulse and system become
obviously affected. In other instances the at-
tack is more sudden, and severer from the be-
ginning, especially when caused by the more
energetic causes — errors of diet and regimen,
by irritating ingesta or intoxicating fluids, by
irritating purgatives, by exposure to cold, to
currents of air, and by damp or wet clothes.
In these latter circumstances especially, it is
sometimes ushered in by chilliness or slight
rigours. It not infrequently follows some one
of the varieties of Diarrhcea or of Colic, espe-
cially the former, and is often attendant upon
it ; in such cases, however, the morbid action
is seldom confined to the small intestine, but is
extended, also, to the mucous surface of the
large bowels.

10. The progress of muco-enteric inflamma-
tion is seldom very rapid, unless when caused
by poisonous substances and the most intense
causes, and then dangerous cerebral symptoms
often supervene, or the morbid action extends
either to the adjoining portions of the aliment-
ary canal, or to the more external tunics. Its
duration most commonly varies from three or
four days to thirty, or even forty ; but thirteen
or fourteen days may be said to be its medium
continuance. It most commonly terminates in
resolution ; but when neglected, or improperly
treated, and in faulty states of the constitution,
it often passes into the chronic form (i^i 11), or
extends to the other tissues of the intestines,
or to the adjoining viscera. A fatal issue gen-
erally is owing to this circumstance, or to con-
secutive affection of the brain, which latter is
a frequent occurrence in children, especially in
infants.

11. i. Chronic inflammation of the mucous sur-
face of the intestines is characterized chiefly by
the presence, generally in a slight degree, of
the symptoms already enumerated, for a con-
siderable time — for six or seven weeks, or even
longer. It may have been consequent upon a
more severe state of the disease, or it may
have been slight from the commencement, and
hence prolonged from this circumstance or from
neglect. In many instances, little or no ab-
dominal uneasiness, or pain, or heat, or flatu-
lence, or distention, is lelt until three or four
hours after a meal. Chronic muco-enteritis
is exasperated by indigestible articles of diet,
by a heating regimen, warm condiments, and
by stimulants. Thirst, dryness of the lips and
mouth ; harshness and dryness of the skin ;
flatulence, borborygmi, and costiveness, the
motions being scybalous, dry, and dark, some-
times alternating with slight diarrhrea ; abdom-
inal distention during digestion, and slight
evening fever, are generally complained of
The occurrence of abdominal pain, tenderness,
thirst, heat of skin, acceleration of pulse, and
lassitude, after the principal meal, imparts to
the complaint an intermittent or remittent char-
acter, which may mislead an inexperienced

practitioner. In some cases, soreness and fis-
sures of the lips, with exfoliation of the epithe-
lium, are observable, and the cuticle often is
thrown off' in minute pulverulent scales.

12. c. hi children muco-enteritis is one of the
complaints most frequently observed. It oc-
curs in either an acute, sub-acute, or chronic form.
In slighter as well as in severer states, it is
common in the youngest infants, more espe-
cially in large or manufacturing towns, and ia
the more delicate subjects ; in whom, however,
the morbid action usually extends to the stom-
ach on the one hand, and to the large bowels
on the other, in a more or less marked form, at
some period of its course. Indeed, many of the
diseases of infancy and childhood are merely con-
secutive upon neglected states of this com-
plaint, more especially cerebral maladies and
convulsions, infantile remittent fever, disor-
ders of the liver, mesenteric obstructions and
enlargements, peritonitis, scrofula, and diseases
of the glands and joints.

13. a. In infants at the breast, muco-enteritis
may, even in the acute and sub-acute states, be
attended by very little febrile disturbance. In
them the symptoms vary with the parts of the
digestive canal principally affected. When the
small intestines are only implicated, there is
generally vomiting, tympanitic distention of the
abdomen, and tenderness upon firm pressure,
with heat of skin, and slight or occasional diar-
rhcea. When the morbid action extends to the
colon, there is more severe or continued diar-
rhoea, much less abdominal distention and ten-
derness, and less frequent or no vomiting. In
many cases of this class of patients an erythe-
matous redness is observable around the anus.
The tongue is dry, or loaded, and red at the
point or edges, and sometimes over the whole
surface. The stools are various, but frequent-
ly consist of a yellowish substance. There are
also thirst, dryness of the skin, and agitation ;
but the pulse is often not much affected.

14. During the period oi dentition infants are
often attacked in a still more severe manner.
In many the complaint commences insidiously
with slight diarrhoea and flatulent distention of
the abdomen, and proceeds in this manner for
some time, until it assumes a well-marked form.
The evacuations are occasionally not more fre-
quent than usual ; sometimes they are three,
four, or five in the twenty-four hours, but they
are loose, and more or less disordered; and all
the local and constitutional symptoms are se-
vere. In the fully developed state of the com-
plaint there are heat of skin, fretfulness, thirst,
dry tongue, disturbed sleep, sometimes vomit-
ing, accelerated pulse, abdominal tenderness on
firm pressure, and distention, crying and agita-
tion before passing a stool, which is often for-
cibly ejected with much flatus. The evacua-
tions vary remarkably in the course of the dis-
ease, from a healthy to a clay-coloured, yeasty,
pale, and slimy, or to a greenish, or brownish,
or reddish, watery and dark state. They some-
times consist of a dark fluid ; at other times,
of a dark or reddish-brown mucus. Their ap-
pearance is, however, much influenced by the
food and medicine taken, much of the former
passing off in the stools, but little or not at all
changed. This acute state of disease may con-
tinue for some time ; but great exhaustion, rap-
id pulse, dry or crusted tongue, sunk eyes, pal-

INTESTINES — Inflammation of Small — Symptoms.

661

lid or waxen countenance, coma, and partial or
general convulsions frequently supervene and
terminate existence. In infants and young
children, this state of the disease may exist for
a considerable time, and even with much se-
verity, without fever being unequivocally de-
veloped. Vomiting, diarrhoea, colicky pains,
rtatulent distention of the abdomen, tenderness
on firm pressure, and often increased heat, es-
pecially of the belly, are the symptoms which
chietiy indicate, iii this class of patients, the
presence of acute muco-enteritis. Frequently
the fust two of these symptoms alternate.

15. In infants who are either prematurely
weaned, or are attempted to be brought up by
hand, or otherwise insufficiently or improperly
fed, this complaint is very i)rcvalent. Indeed,
it is much more common than any other ; and
in it nearly all the other diseases, to which in-
fants thus circumstanced are liable, actually
originate ; these arising consecutively in con-
sequence of sympathetic disturbance, and the
intimate connexion subsisting between t\\e vi-
tal organs, by means of the organic nervous
system. The complaint commonly called the
" Weantng Brash" is merely a modification of
acute muco-enteritis, in which the irritation of
inappropriate or unaccustomed food not only in-
duces a degree of inflammatory action, but also
an increased secretion ; this latter often, how-
ever, favouring the resolution of the morbid
vascular action. In this complaint the essen-
tial symptoms are those just described, varying,
however, in different cases, according as the
inflammatory irritation is extended either to the
stomach, in the form of Gastro-enteritis, or
to the large bowels, in the form of Ileo-cohtis,
hereafter to be noticed. However modified this
disease may be in children, by peculiarity of
constitution, by combinations of the causes, and
the extent or intensity of the morbid action, it
has a most manifest influence, in all its forms,
to induce sympathetic or consecutive inflam-
mation of either the membranes or the sub-
stance of the brain, or even both, and disease of
the mesenteric glands. After weaning or den-
tition, acute muco-enteritis sometimes assumes
a form which is with difficulty distinguished
from the acute variety of Infantile Revnttent
Fever. Indeed, the one complaint often runs
into the other ; and the more severe state of
the latter disease is frequently complicated, as
will hereafter be shown, with the former, a fa-
tal issue in these being generally owing to this
complication.

16. /?. Chronic muco-enteritis is also frequent
m infants and young children. It is more gen-
erally attended by diarrhoea in them than in
adults ; the dejections being glairy, watery, and
greenish. The belly is tympanitic and large ;
and, as the disease continues, contrasts strong-
ly with the emaciation of the extremities.
About one or two hours after a meal, fretful-
ness, or uneasiness with depression, may be re-
marked, occasioned by an increase of ailment
when the ingesta are passing along the ilium.
There are also thirst, dryness of skin, and often
increased heat of the abdomen, especially to-
wards evening. The pulse is sometimes accel-
erated, and generally small and soft. Tender-
ness and soreness are frequently evinced upon
firm pressure of the abdominal regions, or upon
examination of them by percussion. This state

of enteritis in children seldom continues long
without superinducing enlargement and ob-
struction of the mesenteric glands, and the usu-
al consequences of these lesions. It is often,
also, a complication of the more chronic states
of Infantile Remittent Fever, and not unfrecjuent-
ly the former complaint is mistaken for the lat-
ter, the exacerbations attending it arising from
the effect of food upon the character of the
symptoms, or from the constitutional effects
of irritations of a vital organ, and the periodi-
city which the slighter forms of febrile action
are prone to assume, especially when the local
affection commences in a slight form and ad-
vances slowly.

17. ii. Inflammation of the Glands op the
Intestines. — Glandular Enteritis (Author). —
Entirite Folliculeuse, of French writers. Inflam-
mation of the solitary and aggregated (Peyer's)
glands and of tlie simple follicles (Liebekkuhn's)
is rarely observed as a primary disease, un-
less as a consequence of a peculiar class of
causes, which operate not merely locally in re-
spect of the alimentary canal, but also upon the
system in general. It is scarcely ever a simple
or an unassociated malady ; but generally a
consequence of an antecedent morbid condi-
tion, either of some other vital organ, or of the
constitution — a result of an important lesion of
the vital energy, and of the circulating and se-
creted fluids. Follicular or glandular enteritis
is to be viewed rather as a consecutive or symp'
tomatic affection, than as a primary and simple
disease. Yet it has been considered by several
pathologists, and particularly by MM. Louis,
Roche, and others, as a primary malady, and
the essence of the typhoid forms of fever. That
it forms a most important complication of con-
tinued, and even of remittent fevers, is un-
doubted, as I have already shown (see Fever,
() 462), especially in certain epidemics, and in
those localities where the causes which act
more directly upon the alimentary canal co-oper-
ate with other predisposing and exciting caus-
es of fever. Thus it was a most prominent
feature in the epidemic Mucous Fever (see Fe-
ver, ^ 406), described by Roederer and Wag-
LER, and in that denominated by M. Breton-
NEAU dothincntirite, and ilco-dyclidite by M. Bail-
LY. It is frequently observed in a adynamic,
putro-adynamic, and true typhus fevers, and is
seldom absent when these fevers assume the
enteric character or complication ; and which
they are prone to assume when they arise from
those concurring or exciting causes, which ei-
ther act injuriously on the alimentary canal, or
contaminate the circulating fluids; as putrid
footl, water containing decayed animal or vege-
table matter, &c. It exists also, but in connex-
ion with inflammation of the follicular glands
of the cacum, colon, and rectum, in the adynamic
forms of Dysentery {^ 20, et scq.), as will be
more fully shown in the sequel. Glandular en-
teritis, occurring consecutively of, or as a com-
plication of low fevers (see Fevers, (j 453,
474), necessarily assumes, in its course and
consequences, an acute character ; but it also
occurs consecutively of other diseases, more
especially of tubercular consumption, of tuber-
cles in various organs, and of scrofulous dis-
ease of the joints, bones, and glands ; and in all
these symptomatic relations it presents a chron-
ic form.

662

INTESTINES — Inflammation of Small — Symptoms.

18. In its primary and simple states, glandular
enteritis cannot be advantageously viewed with-
out reference to its special causes. These are,
as respects predisposition, the female sex ; the
earlier epochs of life, particularly those antece-
dent to puberty ; relaxed and lymphatic consti-
tutions ; the scrofulous diathesis ; and persons
possessing a fine white skin, a fair complexion,
and light hair. The more efficient or exciting
causes of follicular enteritis are also peculiar.
These are a cold and humid atmosphere ; low
and damp localities ; an air contaminated with
vegetable and animal miasmas ; the use of wa-
ter rendered impure by putrid animal or vege-
table matters or exuviae ; immature, or stale,
or decayed fruit or vegetables ; animal food
passing into a state of putridity or decay ; all
septic substances taken into the stomach ; im-
mature or spoiled, or musty wheat or rice ; dam-
aged or mouldy bread, biscuit, &c. ; the pro-
longed use of purgatives, and whatever impairs
vital power, and deteriorates the chyle and the
circulating fluid. MM. Bretonneau, Leuret,
and Gendeon, consider that cases originating
in one or more of these causes may generate
an effluvium which may infect healthy persons.
There can be no doubt that these causes, when
they operate upon a number of predisposed per-
sons, and in circumstances favourable to their
injurious impression, and to the accumulation
of the emanations proceeding from the diseased,
will produce a disease capable of propagating
itself in these circumstances ; but the disease
will either be dysentery, or fever with enteric
complication, as shown in numerous instances,
particularly where these circumstances have
been aided by the endemic influences just al-
luded to, and by epidemic constitutions.

19. A. Symptoms. — a. \\\\\\e sporadic and sim-
ple state of glandular or follicular enteritis, the
patient frequently complains, at first, only of
slight disorder of the digestive functions, con-
sisting chiefly of want of appetite, colicky pains,
and relaxation of the bowels, ceasing and re-
curring from time to time. There are also
borborygmi, flatulence, mucous stools, a relish,
chiefly, for the more stimulating articles of food,
a white or loaded tongue, a soft and languid
pulse, and a turbid state of the urine. In other
cases the symptoms are more severe at the
commencement. The appetite is lost ; the
tongue presents a grayish-white or yellowish
coating, and is somewhat red at its point and
edges ; the mouth is clammy, occasionally aph-
thous, with an insipid, sickly, nauseous, or sour
taste ; the breath is disagreeable and foetid ;
and there is tenderness upon firm pressure
around the navel. Borborygmi, and eructations
of an acid and nidorous flatus ; colicky pains,
often followed by flatulent and mucous evacua-
tions, occasionally containing lumbrici ; great
depression of strength ; dusky discoloration of
the skin ; occasional outbreaks of slight but
acid perspiration ; and a small, frequent, and
feeble pulse, are generally also present at an
early period. There is little or no heat of skin,
and but little thirst. Shifting pains in the limbs
are often felt. The urine is thick or turbid, and
deposites a grayish or brick-coloured sediment.
Diarrhoea is neither severe nor of any continu-
ance, unless the glands of the large intestines
are also affected.

20. b. In its more acute or severe states, the

alfection of the glands is seldom confined to
the small intestines, or to the solitary glands,
or to Fever's glands, or to the simple follicles
solely, although either may be chiefly diseased.
In the more complicated cases, particularly
those presenting the forms of adynamic fever
and dysentery, Peyer's or the aggregate glands
are principally implicated ; and the disease ex-
tends from the lower third of the ileum, where
it is most prominently marked, to the simple
follicles and solitary glands of the large bowels,
on the one hand, and to those of the upper por-
tions of the intestine canal, on the other. In
these more acute states, severe pain in the ab-
domen, often extending from the navel to the
right iliac or caecal region, and increased on
pressure ; a loaded tongue, with dryness of the
mouth, and thirst ; symptomatic fever, which
becomes increased towards evening, with a dry,
harsh skin ; depression of spirits ; disinclina-
tion to move ; a dull, and often a sunk state of
the eyes, and discoloration of the lips and
around the mouth, are usually present, and are
commonly attended by fulness or flatulent dis-
tention of the abdomen in general, or more
especially towards the caecal region ; by nausea,
and occasionally vomiting ; and by frequent,
mucous, offensive, ochrey, or otherwise morbid
stools and scanty urine. As the disease pro-
ceeds, it usually assumes all the characters ei-
ther of Asthenic Dysentery, or of Mucous or
Adynamic Fever (see these articles), in a severe
and more or less advanced form, according as
the affection extends along the digestive canal,
or gives rise to exhaustion of the cerebro-spi-
nal functions, and to deterioration of the circu-
lating and secreted fluids. When it assumes
any of the forms of Asthenic or Adynamic Dys-
entery (see Dysentery, i) 20, et seq), the caecum,
colon, and rectum are especially implicated ;
and when it passes into adynamic fever, the ag-
gregated glands, particularly in the lower third
of the ilium, are extensively diseased, ulcera-
tion extending from them to the more external
tissues.

21. c. Inflammation of the intestinal mucous
follicles often assumes, particularly in low and
humid localities, and when occurring epidemi-
cally, or even endemically, as occasionally ob-
served, especially on the Continent, either the
form described under the article Mucous Fever,
or that very closely resembling it, denominated
by M. Petit Entcro-mcsenteric Fever, and which
is described by him nearly as follows ; There
are at first debility, general uneasiness, ano-
rexia, irregular attacks of fever, and diarrhoea.
The countenance is dejected, the eye dull, and
the skin pale or slightly livid, particularly about
the lips and near the alae nasi ; decubitus on
the back ; disinclination to motion ; torpor, and
some degree of prostration of the intellect-
ual powers. The fever is slight or obscure
during the day, but gradually comes on in even-
ing paroxysms, without rigours or much heat,
but with a dry, harsh skin, injection of the eyes,
and slight delirium. There is great thirst ; the
teeth are dry ; and the tongue is covered with
a grayish paste. The stools are bilious or se-
rous, variable in frequency and (juantity, but
are not such as to account for the prostration
of the patient. The belly is soft and not swol-
len ; and little or no pjiin is felt in it, unless on
pressure towards the right side, between the

INTESTINES — Inflammation of Small — Symptoms.

6^3

umbilicus and the crest of the ilium. The
symptoms are gradually increased ; the lips and
alae nasi are slightly retracted ; the cheeks be-
come livid, the eyes sunk and injected, and
somnolence and delirium constant, although the
answers are correct, but painful, (/ontinued
(ever, with nocturnal exacerbations, petechias,
and subsultus tendmum, now appear ; the pulse
is frequent, and very compressible ; the teeth
are covered by sordes, and the tongue with a
brownisii or black crust. The abdomen be-
comes more painful ; sometimes, however, the
pain is confined to its first situation, and is un-
attended by distention ; but in other cases it
is more extended, and is accompanied with
tympanitis. The stools become serous, foetid,
and frequent ; the urine scanty ; and excoria-
tions of the nates, or the situations of blisters,
are disposed to gangrene.

22. d. In many cases, glandular enteritis is
consequent upon fevers, or occurs during conva-
lescence from them. This sequela has present-
ed itself more frequently after some epidemics,
and in certain localities, than in others. It has
been well described by Dr. Cheyne, in his Re-
ports, as it appeared in Dublin in 1817. A pa-
tient in fever has become so much improved
that a speedy convalescence is expected, but in
a few days it is found that strength is not re-
turning ; tlie pulse continues quick, and the ap-
petite, although sometimes restored, is oftener
deficient or capricious. The patient expresses
no desire to leave his bed, and he does not gain
flesh. His tongue becomes dry, and he com-
plains of a dull pain and uneasiness in his belly,
with soreness on pressure, and a degree of ful-
ness. To these succeed looseness of the bow- j
els, with great weakness. Probably at the
next visit, the patient is found lying on his back,
with a pale, sunk countenance, and a very quick
pulse, and without mental energy. Mucous
stools pass from him in bed, and the urine also.
His breathing becomes frequent, and often hic-
cough occurs. Death is now nearly at hand ;
opiates, astringents, and cordials being alike
unavailing.

23. e. In the more severe cases, and particu-
larly when they assume either of the above
forms, the abdominal or local symptoms occa-
sionally become suddenly exasperated. The
patient complains of violent pain in the abdo-
men, which is greatly distended, tense, and ten-
der on the slightest pressure. He lies on his
back, with his knees drawn up. His counte-
nance is anxious and collapsed ; his pulse is
weak, small, remarkably accelerated, followed
by extreme depression and sinking, by quick,
laboured breathing, cold extremities, and occa-
sional hiccough. Death in these cases com-
monly takes place within 24 or 36 hours from
the accession of the severe pain and tympanitis ;
and is owing to ulcerative perforation of the
intestines and consequent peritonitis rapidly
extending over the greater part of the perito-
neal surface.

24. /. In other instances, intestinal hemor-
rhage occurs in the course of the disease, and
sinks the patient more or less rapidly, accord-
ing to its amount relatively to his powers, &c.
In these cases, especially if the blood is poured
out slowly in the small intestines, and in small
quantity, it is more or less intimately mixed
with the other matters passed by stool, and the

evacuations are generally more frequent and
abundant than in other circumstances. Intes-
tinal hajmorrhage, particularly when the blood
is more or less pure, is, however, much more
frequent when ulceration has taken place in the
large intestines.

25. 0-. Follicular or glandular enteritis may,
particularly when occurring in a simple and
sporadic form, assume a more or less chronic or
sub-acute state. But in either of these states it
will hardly be distinguished from the more
chronic forms of muco-enteritis already noticed
{() 11), unless by a more offensive mucous or
muco-puriform state of the stools, and a weak-
er and more frequent pulse ; but these cannot
be relied upon. Very often, also, muco-enteri-
tis and follicular enteritis are associated, es-
pecially in children. Enteritis consequent upon
tubercular consumption is commonly seated
chiefly in the follicles, and is chronic in its du-
ration ; but it is seldom limited to the small
intestines, it generally extending, also, to the
coecum and colon.

26. h. The progress of the simple and spo-
radic states of follicular enteritis is generally
slower, and the duration of it, consequently, long-
er than the progress and duration of similar
grades of muco-enteritis. It seldom proceeds
to ulceration, or the ulcerative process rarely
proceeds far in the situation of these glands
without giving rise to inflammation and enlarge-
ment of the mesenteric glands corresponding to the
diseased intestinal glands and follicles. Indeed,
it is not improbable that consecutive inflamma-
tion, enlargement, and obstruction of the mes-
enteric glands often arise before the follicles
and glands become ulcerated, and yet are owing
to the primary disease of these follicles and
glands.

27. i. In infants and children, glandular enter-
itis is a very frequent disease, particularly
among infants that are brought up by hand, or
imperfectly nourished, or injudiciously fed, and
that live in close, low, and damp cellars and
localities, especially in large and manufacturing
towns. It is frequent, also, at the time of wean-
ing, and in humid, cold, and miasmatous situa-
tions. It often assumes a slight and chronic
form, and then generally occasions mesenteric
disease, which very frequently occurs consec-
utively upon either follicular or muco enteritis,
particularly the former. These two forms of
enteritis are with great difficulty distinguished
from each other in children or infants. Nev-
erthetess, an opinion as to the presence of ei-
ther may be formed from the descriptions fur-
nished above {() 12-19). In the follicular vari-
ety, the snols are more generally mucous, and
the diarrhoea is more marked than in the other
variety. Indeed, mucous diarrhixa in children
is very commonly caused by inflammation of
the intestinal follicles and glands, or by a state
of irritation which is very prone to pass into
inflammation, which will assume either a slight
and chronic, or a severe and an acute form, ac-
cording to the constitution of the patient, and
numerous concurring circumstances. In the
more acute cases, there is more or less fe-
ver, which generally assumes a remittent char-
acter ; and it is sometimes attended by nausea
or vomiting, and always by thirst. The abdo-
men is tumid, uneasy, although not always pain-
ful or tender on pressure. Griping pains are

664

INTESTINES — Inflammation of Small — Symptoms.

often felt, especially before an evacuation ; but
there is no strainings unless the large bowels
become implicated ; and this often is the case
as the disease proceeds ; and it then assumes
a truly dysenteric character, the stools often
consisting of a reddish-hrown mucus.

28. k. The more slight and chronic states of
follicular enteritis in children are apt to be over-
looked, or seldom come under the eye of the
physician until it has passed on to organic
change, generally to enlargement of the folli-
cles or mcipient ulceration, with consecutive
disease of the mesenteric glands. The chron-
ic state of the affection is often the conse-
quence of its slightness or its gradual increase,
which causes it to be neglected, or injudicious-
ly treated, in respect both of regimen and of
medicine. It is frequently, also, produced in
connexion with the more slight or chronic form
of muco-enteritis ; and it often proceeds from
morbid states of the chyle and blood, or, at least,
from causes which operate chiefly by deteriora-
ting these fluids. The chronic affection is as-
certained with difficulty in children and infants,
especially during its early stages. It closely
resembles, not only the chronic form of muco-
enteritis, but also infantile remittent fever and
mesenteric decline. Indeed, the remittent fever
may be altogether symptomatic of it ; or it may
be developed in the course of the fever. I have
seen cases, both in public and in private prac-
tice, conclusive of this intimate connexion— of
these sequences of morbid action. The ad-
vanced state of the chronic disorder may not
differ from mesenteric disease ; for the former
is rarely of long continuance without superin-
ducing the latter. In many cases, the affection
of the glands and follicles is slowly produced
in consequence of general cachexia, or of a
morbid condition of the circulating fluids ; the
constitution, especially the soft solids and sur-
face, manifesting general disease and the di-
gestive organs more or less disturbance, the
stools bemg mucous, offensive, or otherwise
morbid. In children, as well as in adults, it
commonly supervenes, and proceeds to exten-
sive ulceration, during the progress of tuber-
cles of the lungs, and in the course of hectic or
slow fever proceeding from the absorption of
morbid matter or diseased secretions, or from
local sources of irritation.

29. I. The chronic form of glandular enteritis
may terminate in perforation of the intestines,
and in partial or general peritonitis, mesenteric
disease having been previously developed, and
more or less advanced ; but I believe that per-
foration is a less frequent consequence of the
chronic than of the more acute or sub-acute
states of the disease. When consequent upon
the chronic form, it is chiefly when this form
arises from tubercles in the lungs, or when it
occurs in the scrofulous constitution. (See art.
Digestive Canal, '^ 38, et seq.). Hamorrhasyc
from the intestines is probably, also, less fre-
quently caused by the chronic than by the acute
states of the follicular disease — at least, accord-
ing to my observations, although I have met
with several instances of its occurrence in the
chronic variety, consequent upon tubercles and
ulceration of the lungs.

30. iii. Inflammation implicating all the
Coats. — The Enteritis PhlegmonodcaofCvLLKfi ;
E. lliaca of Sauvages ; Hero-entenlis of mod-

ern writers. — Inflammation extending to the celh-
lar, and affecting all the tunics, especially the per-
itoneal. — This variety of enteritis is character-
ised chiefly by the severity and continued du-
ration of the pain of the abdomen, particularly
around the navel ; by frequent vomiting and
great tenderness and tension of the belly ; by
the very accelerated, constricted, small, and
even cord-like pulse ; by the marked tendency
to constipation ; and by the severity of the ac-
companying fever. As the inflammation ex-
tends to the peritoneum, or in proportion as
this coat is affected from the commencement,
these symptoms are prominent, but in vari-
ous grades of severity, according as the dis-
ease is consequent upon muco-enteritis, or upon
strangulation, or upon inflammation of some
adjoining viscus, and according to the causes
which have directly produced it. Sero-enteritis
may thus be either primary or consecutive ; acute
or sub-acute ; but very rarely chronic, unless in
a particular form, in connexion either with
chronic ulceration of the intestines, or with
chronic peritonitis.

31. Description. — A. Acute sero-enteritis, or
phlegmonous enteritis, may occur primarily, par-
ticularly in warm or in tropical countries, and
in warm seasons in temperate climates ; but it
more commonly is co?isegucnt upon some grade
or other of muco-enteritis, although the symp-
toms of the latter may have been overlooked,
or have not fallen under the observation of the
physician. When it occurs primarily, it is gen-
erally ushered in by chills or rigours ; but when
it is developed more gradually, owing to the
extension of inflammatory action from the mu-
cous to the cellular tissue, and thence to the
peritoneal coat, then it is evmced by the ap-
pearance of the more acute and characteristic
symptoms. — a. In the early stage of the disease,
more especially if it be ushered in by rigours,
there is great vascular and febrile excitement,
which passes into exhaustion with a rapidity
proportioned to the degree of the previous ex-
citement, and to the progress of the inflamma-
tion and of its consequences. Pain and ten-
derness of the abdomen are early felt, particu-
larly under pressure, during which the patient
winces, and evinces increase of pain or anguish
by the expression of his face. The abdominal
integuments become hard, irregular, tense,
harsh, and hot, and the whole abdomen tense
and distended, chiefly by flatus, which the pa-
tient feels to increase his sufferings. As the
tenderness increases, he is more constantly on
his back, with his legs drawn up, as if instinct-
ively to relax the muscles and to keep off the
pressure of the bed-clothes from the belly. If
nausea, retching, or vomiting does not appear
at the commencement of the attack, they are
sure to occur as it proceeds, and to increase in
severity with its progress. Constipation is ob-
stinate in proportion as the more external tu-
nics are affected ; and the more obstinate it is,
the more urgent is the vomiting, which often
occurs either without being excited by the in-
gesta, or a considerable time after substances
have been taken into the stomach. The urine
is scanty and high-Coloured. The skin is hot-
ter than natural, and always drier, excepting
on the forehead and palms of the hands, where
it is often moist. The pulse is very quick ; gen-
erally from 100 to 120, or even quicker, in the

INTESTINES — Inflammation of Large — Symptoms.

665

more intense cases, and at a far advanced pe-
riod. It is small, constricted, resisting, and
firm ; but as exhaustion comes on, it becomes
small, thready, and weak. The respiration is
quick and anxious, and chiefly effected i)y the
diaphragm and intercostals, the abdominal mus-
cles acting slightly or almost imperceptibly.
The tongue is covered by a whitish fur, and
there is excessive thirst.

32. b. As the vascular and febrile excitement
passes into exhaustion, the abdomen becomes
more distended and tense, and the pain and ten-
derness, which had recently been most intense,
subside more or less rapidly. The concentra-
tion of heat in the addomen still continues,
while the temperature of the extremities sinks.
Respiration now becomes laboured ; retching
and vomiting more frequent, and the counte-
nance more anxious and collapsed. As the
stage or period of exhaustion is more fully
evolved, the pulse is remarkably quick, general-
ly ranging above 120, and weak, small, thready,
or undulating. The heat of the surface falls
remarkably on the extremities, which arc damp
and clayey cold, and, ultimately, even on the
trunk. The hands and feet often appear mot-
tled with dark-red or livid spots. Respiration
is irregular, embarrassed, or interrupted by
catchings or hiccough. Vomitings occur with-
out retchings or effort, the contents of the stom-
ach being discharged by a retrograde action, or
by a guiping-like motion. The tongue is dry,
brown, and furred ; the face is sunk, the orbits
hollow, and muscular power altogether pros-
trate. This slate continues but a short time,
until the patient sinks, generally with a collect-
ed mind, and sometimes with hopes of recov-
ery entertained until almost the last moment,
or after all hopes have ceased to inspire the
practitioner.

33. B. Sub-acute serocnleritis differs from the
acute chiefly in the severity of the symptoms
and in their duration. The abdominal symp-
toms are less severe in this than in the acute
form ; and the attendant fever is also less.
The acute variety is seldom protracted beyond
the sixth or seventh day, very often not beyond
the fourth ; whereas, the sub-acute maybe pro-
longed to twelve, fifteen, or even twenty days.
The rapid progress even of the latter, and still
more of the acute, should not be forgotten, nor
their almost constant tendency to terminate fa-
tally, as these circumstances most unequivo-
cally prove the necessity for adopting a most
active, decided, and a judicious treatment at the
commencement of the disease ; for, when ex-
haustion begins to appear, every means will be
ineflScacious.

34. Althougha cute and sub-acute phlegmo-
nous or sero enteritis most frequently arises
from the extension of inflammation from the
mucous coat to the connecting cellular tissue,
and thence to the external tunics of the intes-
tines, yet these tissues may be almost coeta-
neously affected, or the inflammation may com-
mence in, or extend to, the serous coat, and
thence to the rest. This latter is most likely
to he the case when sero-enteritis appears con-
secutively upon external injuries, ujion inflam-
mations of adjoining parts, and upon strangula-
tion. &c. Death, in the unfavourable cases of
acute and sub-acute sero-enteritis, is conmion-
ly caused by the extent to which inflamma-

tion and its consequences have proceeded in a
vital organ, and by the shock imparted to the
organic nervous power by intense disease of a
viscus most intimately connected with this vi-
tal part of the nervous system.
II. Inflammation of thk Large Intestines. —

Syn. Colitis, Colite, Ft. Eine enlsiindung des

Kolons, Germ.

Classif. — III. Class, I. Order {Author).

35. Defin. — Pain and tenderness in the course
of the colon, commonly originating in the region of
the ccecum, and extending to the left iliac region
and sacrum; with frequent, and often ineffectual,
efforts at f cecal evacuation, generally preceded hy
tormina, and attended by tenesmus, the motions be-
ing mucous, and streaked with blood; symptomat-
ic inflammatory fever.

36. The ccecum is sometimes primarily infla-
med, without the disease advancing to a great
extent, either to the small intestines on the
one hand, or to the colon on the other. This
limitation of the inflammation to the cajcum is,
however, comparatively rare, especially when
its mucous surface is the part of it affected.
Inflammation of the cacum, particularly when
thus confined, is fully treated of in the article
C.'EcuM (>J 15). When inflammation commen-
ces in this viscus, it generally extends to the
colon, and even to the rectum ; less frequently,
it extends also to the ilium. When this latter
intestine is inflamed, especially when its villous
surface or its follicles are chiefly affected, the
cffcum often participates in the disease, which
frequently advances, also, to the colon and rec-
tum. Such is the case in the several varieties
of Dysentery, which, in most instances, either
commences with, or soon passes into, inflam-
mation of the mucous surface of the large in-
testines, extending often to the ilium. In the
purely inflammatory form of dysentery, the lo-
cal morbid action is of the sthenic kind, and
the accompanying fever, also, of this nature.
In the low, adynamic, infectious, and epidemic
forms, the local action is asthenic, and the at-
tending fever of a low or typhoid character.
In most of the forms of dysentery, there are
portions of the large intestines somewhat more
severely implicated than others, and these are
the internal surface of the ca;cum, of the sig-
moid flexure of the colon, and of the rectum.
The other portions of the colon and the ilium
are likewise inflamed, but generally in a less
degree, unless in very severe or protracted ca-
ses, where they also present very remarkable
lesions. In the different states of dysentery,
also, the follicular glands, as well as the mu-
cous surface itself, are affected, although prob-
ably in different degrees, particularly at the
commencement of the complaint, at which pe-
riod, however, dysentery is not always identi-
cal with inflammation of these parts, for dys-
entery, particularly in its asthenic, endemic,
and epidemic appearances, usually commences
with indications of morbid secretion and of inor-
dinate action of the muscular coats of the intes-
tines — with signs of irritation chiefly ; inflam-
matory action, either of a sthenic or asthenic
kind, being consecutive. However, in many of
the more acutely and sthenically inflammatory
cases, and especially in those which occur spo-
radically, and from causes which will hereafter
be noticed, this disease is truly inflammation
of the villous surface of the large intestines,

666

INTESTINES — Inflammation of Large — Symptoms.

seated, in some cases, chiefly in the colon and
rectum ; in others, in the caecum and colon ;
and, in many, in these three parts equally, and
extending also to the ilium ; but in all, the
morbid action is not limited to the villous sur-
face itself, nor to the follicular glands solely
of these intestines, although it may commence
in either, or be more prominent in one or the
other.

37. Inflairimalion of the Colon — Colitis — which
will be chiefly considered at this place, as In-
fiammation of the C^cum and Inflammation of
the Rectum are discussed in separate articles
— generally commences in the villous or mucous
surface, or in the follicles, and comparatively
seldom in the cellular or connecting tissue of
the coats of this bowel, or in the peritoneal
coat. It may, however, originate in either of
these latter, as in the case oi phlegmonous enter-
itis (9 30), when it has been caused by wounds
or external injuries, by strangulation, or has
occurred consecutively upon inflammation of
an adjoining viscus, or of the peritoneum, or
of the omentum or mesentery.

38. A. Symptoms of Acute Colitis. — When the
inflammation commences in the villous surface,
as is usually the case, the bowels are, at first,
loose or irregular, or mucous diarrhcea is pres-
ent, feculent evacuations being first passed.
In this state there may be neither chills nor
rigours, or they may be slight. When, howev-
er, the coats of the bowels are more deeply and
acutely affected, the disease is usually ushered
in with rigours and chills. Pain and tenderness
on firm pressure are generally felt in the course
of the colon, extending from the caecal region
to the right hypochondriuni, across the abdo-
men, midway between the pit of the stomach
and navel, to the left side and left iliac region.
The pain occurs in paroxysms, is often griping,
arul followed by an inclination to go to stool,
the evacuations consisting chiefly of mucus
with blood. If there be straining or tenesmus,
with pain in the direction of the sacrum, the
inflammation has extended to the rectum. If
inflammation of the large bowels assumes a
sub-acute form, it is attended by the same symp-
toms, and it observes the same course, as sta-
ted in the article Dysentery, at the place where
the sthenic or inflammatory states of that dis-
ease are described (i) 11-16). If it be very
acute, it will differ but little, if, indeed, at all,
from the variety of dysentery (^ 17, et seq.) ob-
served so frequently m Europeans in warm and
inter-tropical countries. Indeed, the chief dif-
ferences between colitis, or inflammation of the
colon, and inflammatory dysentery, arise from
the extension of the morbid action, in the lat-
ter, to the rectum on the one hand, and to the
caecum, and even, also, to the ilium, in some
cases, on the other. When, however, the rec-
tum is unaffected, there will neither be strain-
ing, nor pain at the sacrum, the other symp-
toms attending acute inflammatory dysentery
remaining; the inflammation of the rectum, in
connexion with colitis, occasioning some of the
chief characteristics of inflammatory dysentery.
(See article Rectum.)

39. When inflammation has invaded all the
coats of the colon, either by extending from the
internal surface to the peritoneal coat, or from
the latter to the other tissues, or by attacking
them all nearly coetaneously, the second and

third modes being, however, comparatively
rare ; then pain, increased heat, and tender-
ness in the course of this viscus, become more
severe and constant, and extend over the ab-
domen ; flatulent distention of it increases, par-
ticularly in parts ; the stools are preceded by
tormina ; are frequent, scanty, mucous, or sli-
my, very dark, streaked with florid blood ; con-
tain either scybala, or broken-down faeces ; are
passed with much flatus ; and are at last foetid,
with shreds of lymph or muco-puriform matter
in them. The tongue varies in its appearance,
but it usually becomes covered with a dark
sordes, which forms into a crust as the disease
proceeds. The mouth is dry : there is con-
stant thirst, and occasionally vomiting. The
urine is scanty and high-coloured, and the calls
to pass it, frequent and painful. The pulse is
quick, hard, and small, and ultimately small
and weak. The heat, pain, tenderness, and
flatulent distention of the abdomen go on in-
creasing, and the disease, in most respects, ex-
cepting the dysenteric symptoms, assumes the
features of the worst cases of sero-enteritis
(^ 31), or passes into a state of partial or gen-
eral Peritonitis, or becomes identical with the
far-advanced stage of the most acutely inflam-
matory form of Dysentery (^ 17) ; the local
and constitutional symptoms attending the un-
favourable terminations of these, particularly
of the last, also accompanying similar termi-
nations of it. As colitis, however, appears
more frequently associated with other diseases,
than as a primary malady, especially with in-
flammations of other parts of the alimentary
canal, o-r with those of the liver, omentum, peri-
toneum, &.C. ; and as it occurs in a variety of
endemic and epidemic circumstances, and in
various states of the constitution, so both the
local and constitutional symptoms vary in dif-
ferent cases, and even in different stages of
the same case. Still, the pain, heat, distention,
and tenderness in the course, or in some part
of the colon, in connexion with the state of the
stools and the severity of the local and consti-
tutional disturbance, will sufficiently mark the
presence of the disease.

40. B. Chronic inflammation of the colon —
chronic colitis — is either consequent upon the
acute or sub-acute states of colitis, or is itself a
primary disease, the chronic condition pro-
ceeding from its slight grade and slow prog-
ress. As it usually occurs in practice, it is
identical with the sub-acute or chronic forms of
Diarrhcea and Dysentery (^ 45, et seq.), the
symptoms varying much according to its com-
plications, and the circumstances of the locali-
ty in which it prevails, and of the individual
affected, as above stated (ij 39). Its most com-
mon complication, however, is with sub-acute
or chronic disease of the liver, with abscess
in this organ, and with disease of the mesen-
teric glands ; but it may attend other diseases,
particularly tubercles in the lungs. The symp-
tomatic fever, in this state of colitis, is very
frequently of a remittent or hectic type ; and
it often, particularly in warm and miasmatous
climates, occurs in the course, or as a sequela,
of intermittent and remittent fevers.

41. Chronic colitis generally occasions, and
becomes associated with, chronic inflammation
of the ileum, the disease affecting chiefly either
the mucous surface, or the follicles of this in-

INTESTINES— Inflammation of— Svmptoms.

667

testine ; but in this case the cceciim also is
more or less implicated. As this state of co-
litis proceeds, ulceration takes place ; and the
inflammation advances in parts, through the
medium of the connecting cellular tissue, to
the peritoneal coat, coagulable lymph being
thrown out on its surface, and giving rise to
adhesions, &c. Similar changes, although to
a less extent, also take place in the adjoining
portions of the alimentary canal, and the dis-
ease terminates either in partial or in general
peritonitis, or in thickening and constriction
of the coats of the intestine, or as more fully
described in the article Dvsenterv {() 48-58).
III. Inflammation of both Small and Large
Intestines. — Ilea- colitis — Entero-colitis, of
various authors. Ilco-colile — Entero-colite,
Fr. Entziindung des Ileums u. dcs Colons,
Germ.

42. This is a frequent fbrm of inflammation
of the intestines, the morbid action affecting
the ilium and colon solely, but in different
grades in either, or extending also to the oth-
er portions of the small and large intestines,
although in various degrees. It is probable,
however, that the disease is not limited long
to the ilium and colon without the rectum being
more or less affected ; and we cannot reason-
ably exclude the caecum from an equal share
of the malady when the ilium and colon are at-
tacked. Indeed, there is reason to believe that
the ccecum is sometimes the part first affected,
inflammation extending to the colon on the one
hand, and to the ilium on the other, especially
when the mucous surface is the tissue primari-
ly attacked.

43. A. Acute Ileo-colitis. — a. The symp-
toms vary according to the portion of intestine
chiefly affected ; but the most characteristic of
the more acute states are, pain, aching, or sore-
ness, with frequent gripings in the right iliac
region, and between this part and the umbili-
cus, often extending across the hypogastrium,
and occasionally above and around the navel ;
tenderness on firm pressure of these places ;
diarrhoea, the stools being thin, mucous, or wa-
tery ; and symptomatic fever. At the com-
mencement of the slighter cases, there may be
neither chills nor rigours ; or they may be slight,
or they may recur and alternate with febrile
heat ; but they generally usher in the more
acute attacks. As the disease is developed in
its acute form, the patient complains of a sense
of heat in the above situations, particularly in
the region of the ileo-caecal valve ; and of flat-
ulent distention, pressure frequently causing
a gurgling sound in this region. The abdo-
men is hot, dry, and more and more painful,
distended, and tender on pressure as the in-
flammation proceeds. The stools become more
disordered, darker, more offensive, mucous, or
watery, and occasionally streaked with blood,
or contain imperfectly- digested substances.
The complaint, when judiciously treated, will
generally not proceed farther, all the symp-
toms gradually subsiding ; but when it is neg-
lected, and when it is complicated with dis-
ease of the liver or other organs, or associated
with remittent or adynamic forms of fever, or
when it extends to the rectum, thereby giving
rise to a most severe and dangerous form of
dysentery {() 17), the inflammatory action very
often proceeds to disorganization, the perito-

neum ultimately becomes implicated, and the
several lesions described in the article just re-
ferred to ((^ 59, ct seq.), and in that on the pa-
thology of the Digestive Canal ((J 34, et seq.),
supervene and terminate life.

44. b. Inflammation of both the small and large
intestates seldom extends, in temperate cli-
mates, to all the coats or tissues of all these
viscera in the same case. When inflammatory
action attacks or extends to all the coats, or
even to the peritoneal coat, portions only of ei-
ther the small or large bowels are thus impli-
cated : more rarely of both. Yet I have fre-
quently observed, particularly in warm cli-
mates, all the coats — the mucous and perito-
neal inclusive — inflamed both in the ileum and
in the colon, including the cajcum and even the
rectum. In these cases, the disease commen-
ced either as inflammatory diarrhoea, or as in-
flammatory dysentery, the morbid action ex-
isting in the mucous surface of the ileum and
colon in tire former, and in the rectum, also, in
the latter, ultimately extending to all the tu-
nics, in portions of these intestines, and giv-
ing rise to partial or general peritonitis, and
to the other consequences of enteritis already
noticed, with the symptoms attending them, in
their most severe and most prominently marked
forms, or in the form about to be described.
When the inflammation proceeds thus far, the
chances of recovery are very few, the change
of structure already produced on the internal
surface of the intestines combining with the in-
tensity of the morbid action, and with its con-
sequences in the external coats, in destroying
the patient. In these, the symptoms vary much
in different cases, according to the part chiefly
affected, and the other circumstances connect-
ed with the production and course of the dis-
ease ; but either a combination of the local
symptoms characterizing both sero- enteritis
(^ 30) and scro-colilis {'!) 39), or a predominance
of the symptoms of either, with great febrile
commotion — with heat of surface, particularly
of the abdomen, very quick, sharp, constricted,
hard, and small pulse ; dry tongue, thirst, oc-
casionally vomiting ; scanty, high-coloured
urine ; and ultimately physical exhaustion, sin-
gultus, or flatulent eructations, cold extremi-
ties, (fee. When the morbid action thus in-
vades the external coats of the bowels, the
diarrhoea subsides, and constipation often takes
place, the seat of pain and of tenderness gen-
erally indicating the portion of the bowels chief-
ly affected.

45. B. Ileocolitis of Warm and Inter-
tropical Countries. — a. Inflammation of the
small and large intestines is of frequent oc-
currence among Europeans residing in intertro-
pical countries, and, indeed, among the inhab-
itants of all hot climates. It generally com-
mences in the villous coat, but it occasionally
attacks all the intestinal tissues almost simul-
taneously, or the peritoneal coat chiefly, par-
ticularly when it is caused by exposure to cold
in any way, or by sudden suppression of the
perspiration. When it originates in the vil-
ions surface, it is often owing to, or, at least,
connected with, a morbid condition of the
bilary and other secretions poured into the
intestinal canal, the alvine evacuations being
more or less disordered. It rarely commences
in the peritoneal coat, unless consecutively upon

668

INTESTINES— Inflammation of— Symptoms.

inflammation of the liver, with which it is often
complied ted, especially in India. At first, the
bowels are seldom obstinately constipated, but
they are sometimes costive ; they are oftener,
however, la.xcr than usual, and diarrhcsa is
present in many cases. Indeed, the disease
often commences in the form of inflammatory
diarrhoea, or of dysentery, and continues in ei-
ther of these, particularly the former, as long
as the villous coat and follicles only are af-
fected. The stools are morbid, of various col-
ours, and frequently change their appearance.
They are offensive, often dark-coloured, wa-
tery, or serous — sometimes pale, fluid, and
frothy, resembling fermenting yeast ; at other
times they are slimy-green, gelatinous, or mu-
cous. As the disease advances, they are of a
dark green, with lighter shades, or with brown
or yellowish-brown streaks, and at last they
become very dark and grumous, occasionally
bloody, especially when the colon is much af-
fected.

46. b. As the inflammation extends to the
other coats, the griping pains, which manifest-
ly, from the morbid appearances of the motions,
arise from, or are increased by, the irritation of
disordered secretions, are attended by more
continued suffering, and by a sense of internal
heat, or burning, with great soreness and ten-
derness of the abdomen upon pressure. The di-
arrhoea subsides, and the stools become scanty ;
and attempts at evacuation are accompanied
with violent e.xaccrbations of pain. The tongue
is white, excited, red at its point and edges, and
afterward very loaded at its middle and base.
The strength, especially of the lower limbs, is
remarkably prostrated. The pulse is quick, soft,
and small. Vomiting occasionally occurs, par-
ticularly after cold fluids taken to quench the
urgent thirst. The abdomen is generally hot,
tense, and tender. As the disease advances
through the parietes of the bowels, the above
symptoms increase. The stools, which were
previously, and while the internal surface of
the intestines was chiefly affected, of a watery,
serous, mucous character, sometimes streaked
with blood, now become more scanty and mor-
bid ; the abdomen more tumid, painful, and ten-
der, and vomiting more frequent and distressing.

47. c. When the inflammation commences in
what has been called the phlegmonoid form,
seizing at once upon the different coats of the
bowels, the symptoms are much more acute
and violent from the first. The patient com-
plains consecutively upon, or coetaneously with,
cold chills or rigours, of sharp pains around the
umbilicus, in the right iliac region, or between
these regions, and extending down to the hypo-
gastrium. The pulse is hard, quick, and con-
stricted, or small. The tongue is loaded, clam-
my, and dry. The bowels are irregular or con-
stipated, and inefliciently acted upon by cathar-
tics, until depletions have been freely practised.
When the disease commences in this form, its
progress is very rapid. The face soon becomes
anxious ; the stomach irritable, and the vomit-
ings frequent ; the tongue deeply coated, dry,
and brown ; the abdomen very tense, tuinid,
and tender ; the skin, particularly over the
trunk, very hot, harsh, and dry ; the calls to
stool most distressing and unsatisfactory ; the
urine very scanty and high-coloured ; and the
respiration suppressed, and chiefly intercostal.

If the disease is now arrested, all these symp-
toms increase in violence. The features are
sharp and anxious ; the patient lies on his back,
with his knees drawn up ; the hands and feet
are cold and clammy, while the abdomen is hot ;
the pulse is small and weak ; the breathing la-
boured, hurried, and irregular, sometimes diffi-
cult, or attended by hiccough. The pain and
tenderness are often more diffused over the ab-
domen, extending to the hypochondria and hy-
pogastrium ; and the distention is augmented.
At last, exhaustion, cold sweats, faintness, hur-
ried respiration, singultus, with increased ac-
tion of the al(B nasi, collapse of the features ; a
weak, small, thready pulse, extreme restless-
ness, and death, supervene.

48. C. Sub-acute and Chronic Ileo-colitis.
— a. The sub-acute and chronic states of ileo-co-
litis, particularly in the slighter cases, differ in
nothing from the serous and mucous varieties of
Diarrhcea (^ 9-12). I have shown, in that ar-
ticle, that these varieties of diarrhcea, although
generally commencing in irritation, usually de-
pend, especially in children, upon inflammatory
action, seated chiefly in the mucous surface and
follicles of the ileum, caecum, and colon ; and
that these, as well as some other forms of di-
arrhoea (ij 13-18), particularly when severe, of
long duration, or attended by fever, pain, or ten-
derness in the situations stated above (4 43),
always present the usual consequences of in-
flammation of these parts upon examinations
after death. The symptoms, therefore, of sub-
acute and chronic ileo-colitis are identical with
those described as attendant upon the inflam-
matory states of Diarrhcea.

49. b. The more chronic states of ileo-colitis
are most frequently associated with visceral dis-
ease of a chronic, and sometimes obscure kind.
They most commonly attend tubercular consump-
tion, and in this case the mucous follicles and
the solitary intestinal glands are chiefly affect-
ed, and contain, in the early stage, tubercular-
like matter. Chronic disease of the liver, and
enlargement of the mesenteric glands, are also
frequent complications, the former generally
preceding, the latter supervening upon the in-
testinal affection. The acute and sub-acute
forms of ileo-colitis are often associated with
inflammation of the substance of the liver, and
with certain endemic and epidemic fevers, of
which, however, they are usually consecutive.
Chronic ileo-colitis is seldom a simple disease,
but, in its different complications, the affec-
tions which precede or occasion it, as well as
those to which it gives rise, should be ascer-
tained before the intentions of cure be resolved
upon. When the disease affects the rectum
and sigmoid flexure of the colon, the desire to
go to stool is almost constant, and the strain-
ing often urgent. In this case, the complaint
becomes identified with chionic Dysentery.

50. c. The symptoms of chronic ileo-colitis
differ but little from those of chronic diarrhoea.
When the colon is but slightly affected, the
stools may not be very frequent ; but if it be
the chief seat of the disease, there will be more
or less diarrhoea, the evacuations being yellow-
ish, greenish, or clayey, or even muco-puriform
in a more advanced stage, or when ulceration
has taken place. Uneasiness and soreness ere
usually felt in the abdomen, and sometimes pain,
at one place acute, at another dull, or fixed, or

INTESTINES— Inflammation or.

669

moveable. These sensations are exasperated
6ome time after a meal, also by moral emotions,
by violent exercise, or by the motions of a car-
riage. The tongue is often not materially af-
fected ; it is sometimes pale. The appetite,
particularly when the disease is symptomatic
of tubercular consumption, is often not materi-
ally impaired. At an advanced stage, the ab-
domen is usually large and tympanitic, contrast-
ing remarkably with the emaciated extremities,
especially in children. In this class of patients,
mesenteric disease supervenes on the intesti-
nal affection, and marasmus is produced. In
some cases, however, especially in adults, the
abdomen is either not swollen, or is even more
than usually sunk. A short, dry cough fre-
quently attends the latter periods of the dis-
ease. The duration of chronic ileo-colitis is in-
determinate. It is often recurrent, intermit-
tent, or remittent, presenting longer or shorter
periods of remission, or of immunity from dis-
order, especially in its slighter states and ear-
lier stages. But it generally recurs upon slight
errors of diet or regimen, or after exposures to
cold or humidity.

51. D. PsEiTDo-MEMBRANOus Enteritis. — En-
tcrite ■pseudo-membrancuse, Cruveilhier. — a.
This Ibrm of enteritis was first described by
Dr. Powell. (Med. Trans, of Col. of Physic,
vol. vi., p. 106.) It has more recently been
observed by Cruveilhier, Andral, Gendrin,
Guibert, Bretonneau, and myself. It rarely
appears in an acute, but generally in a sub-acute
and chronic form — the latter especially ; or, in
other words, acute inflammation of the villous
surface of the bowels is rarely attended by the
formation of a false membrane on its surface
to any extent, although portions of coagulated
lymph of considerable size are occasionally
passed along with the other matters evacuated
in the advanced course of the disease. Pseudo-
membranous enteritis is most frequently cArc*«ic
and intermittent, or, rather, it may be said to de-
pend upon a latent and prolonged state of in-
flammation, extending along a very large por-
tion, sometimes the greater part, of the intes-
tinal canal, as evinced by the quantity thrown
oil"; the most prominent symptoms subsiding
for a considerable time, and reappearing after-
ward, and continuing, with more or less severi-
ty, until the false membrane produced by it is
detached and discharged. I have met with two
cases of this disease in its most severe forms,
and several instances in a much slighter de-
gree. Both the former, and most of the latter,
occurred in females, in which sex all the cases
observed by Dr. Powell also occurred.

52. b. The symptoms are often very slight,
and consist chiefly of a sense of soreness, slight
heat, and tenderness on firm pressure of the
abdomen. The bowels are generally irregular,
either too relaxed or too costive, and rarely
natural, as respects either the times of evacua-
tion or the state of the motions. After con-
siderable intervals, sometimes of several weeks
or even longer, colicky and violent abdominal
pains are experienced, and the stools after-
ward passed contain shreds of false mem-
brane of various sizes, occasionally formed
into complete tubes of considerable length.
These formations are occasionally white and
soft, and sometimes yellowish, consistent, and
even elastic. From their appearances, as well

as from the symptoms preceding their dis-
charge, there is reason to infer that they may
be produced in any part of the intestinal canal,
or in both the small and large bowels at the
same time. While the symptoms are often so
slight as hardly to occasion any inconvenience,
they are sometimes much more severe in re-
spect both of the intervals and of the painful
attacks preceding the evacuation of these mor-
bid productions. In these, the symptoms of
chronic muco-cntcrilis, or of chronic Uio-colitis,
are generally present. Heat, soreness, aching,
or dull or acute colicky pains, are felt at inter-
vals ; but these pains are seldom increased by
pressure, although soreness and aching are
usually aggravated by it. After slighter or se-
verer local symptoms of this kind being occa-
sionally felt for some weeks, or even longer,
and augmented by any error in diet, or depar-
ture from an abstemious regimen, a more vio-
lent attack occurs, and resembles either severe
colic, or the symptoms attending the passage
of biliary calculi into the duodenum. The bow-
els then generally become more lax, and the
stools contain portions of false membrane,
which continue to be voided for two, three, or
four days, three or four evacuations often ta-
king place daily. Occasionally the bowels do
not act spontaneously, the discharge of these
membranes being assisted by medicine. The
severe symptoms afterward subside, until the
morbid formation is again developed, and be-
gins to be detached. The pulse is sometimes
not affected, but it is often somewhat accelera-
ted. The tongue is usually covered by a
whitish or yellowish-white mucus or coating,
and is seldom red at its point or edges. The
appetite is impaired ; there are thirst, and much
flatulence of the stomach and bowels ; but the
temperature of the surface, the state of the
skin, and the urine, are not materially affected.
During the severity of the paroxysm, vomit-
ing frequently takes place ; and Dr. Powell
observed jaundice precede it, probably owing
to an inflamed state of the villous coat of the
duodenum having prevented the discharge of
bile into the intestines, or to the false mem-
brane extending over or into the common duct.
53. Dr. Powell states, that in all the cases
he observed there was indigestion, with fre-
quent recurrence of pain ; that the more vio-
lent seizures consisted in sudden and excess-
ive pain, frequently increasing in paroxysms,
and rather relieved by pressure, but leaving
great soreness and tenderness during the inter-
vals ; and that this state continued under four
days, the stomach during it being very irritable,
and the tongue clammy and coated. This phy-
sician justly considered the false membranes*

* A lady, who came from Yorkshire to be under my care,
and remained several months in London, was the sul)ject
of this complaint, associated with Hysteria in its most se-
vere and cuniplicatfd form, and occasionally amounting tu
cat.'ilepsy. Siie experienced a recurrence of the more pain-
ful seizures every four, five, or six weeks, followed or at-
tended by the discharge of the false membranes in larso
quantity, and sometimes in the form of perfect tubes. The
catumeiiia were always most painful, somewhat irregular,
attended by vomitings and severe abdominal pains, yet abun-
dant ; but they were also accompanied with the discharge
of shreds of false membrane from the uterus. The dis-
charjje of the membranes from the bowels and vagina was
not, however, contemporaneous, although sometimes nearly
so. The nature and the severity, the rare complication, and
the persistence of the disease, led to consultations, other phy-
sicians thus also witnessing this almost singular case.

670

INTESTINES — Inflammation op— Complications.

thus discharged to have been formed in a simi-
lar manner to those observed in croup, and, in
a few instances, in bronchitis. (This subject
is farther noticed in the article Digestive Ca-
.VAL, Hfi) 48.)

54. IV. Associations or Complications. —
Several of these have already been noticed.
The follicular variety of muco-enteritis is often
associated with adynamic or typhoid fevers, or,
rather, it occurs as a frequent complication of
these fevers, especially m certain localities,
epidemics, and circumstances, to which suffi-
cient allusion has already been made {^ 17).
Its complication with tubercular consumption,
also as a consequence of that malady, has like-
wise been stated (<J 17). With disease of the
mesenteric glands it is likewise very often asso-
ciated ; but in this complication it is generally
tlie primary afiection. Muco-enteritis is very
commonly connected with disorder of the biliary
functions and with disease of the liver, particu-
larly in India and warm climates. Either affec-
tion may be consequent on the other, but most
frequently enteritis is the secondary disease.
When matter is formed in the substance of the
liver, follicular enteritis, with diarrhoea, or a
chronic form of dysentery, is produced ; but not
so much by the acrid or otherwise disordered
bile discharged into the intestines as by a mor-
bid state of the blood, caused by the absorption
of a portion of the matter from the liver. The
blood thus contaminated induces disease of
the intestinal follicles, and particularly of Fev-
er's glands. It is only when the surface of the
liver IS inflamed that the disease sometimes
extends to the peritoneal surface of either the
small or the large intestines, inducing sero-en-
terilis, or sero-ileo-colitis, the omentum, and even
the mesentery, being sometimes also implicated.
It is, however, not improbable that disease
of the follicles, particularly if ulceration have
taken place, wdl occasionally be followed by
the passage of morbid secretions into the por-
tal circulation, inflammation of the portal veins
and abscesses of the liver being thereby occa-
sioned. Jaundice is also sometimes compli-
cated with muco-enteritis, and may arise either
from disease of the liver or ducts, or from ex-
tension of the inflammation to the common
duct, or the occlusion of its opening into the
duodenum, owing to turgescence of the sur-
rounding tissue.

55. Inflammation of the internal surface of
the small intestines sometimes extends from
the duodenum to the stomach and gastritis, as
respects the villous coat, being complicated
With muco-enteritis. In some instances the dis-
ease proceeds in an opposite direction, and in
others both the stomach and intestines are
nearly coetaneously afTected ; this latter occur-
rence being very frequent in fevers. Indeed,
inflammation of the villous coat of both the
stomach and intestines constitute one of the
most common and important complications in
remittent, malignant, and exanthematous fevers ;
but this part of my subject is fully discussed in
the article Gastro-enteric Disease (i^ 10, et
seq.). The various forms of enteritis, but es-
pecially muco-enteritis, very frequently appear
as complications in the course of scarlatina,
smallpox, and measles^ although often in slight
or latent states, or more or less masked by the
other phenomena of these maladies. In scarla-

tina, gastro-enteric inflammation is a part of
the morbid conditions invariably present in
some grade or other, or, in other words, inflam-
matory injection of the villous surface of the
stomach and intestines is as constantly present
as the same condition of the vascular rete of the
skin, and most probably at a still earlier period
of the disease, and to a much greater extent,
when the eruption either is imperfectly devel-
oped on the surface, or disappears from it pre-
maturely. This, indeed, is demonstrated by the
symptoms in all cases, wherein they are care-
fully observed. The affection of the intestinal
mucous surface, more especially in those cases
just alluded to, is evinced by pain, tenderness,
tension, and fulness of the abdomen, and by
nausea, vomiting, or diarrhoea ; the stools be-
ing serous, dark-coloured, and containing flakea
of lymph of a much lighter colour. In the com-
plication of scarlatina with enteritis, the villous
coat itself is the part chiefly affected ; while in
that of smallpox with enteritis, the mucous fol-
licles are often implicated. In the advanced
stages, however, of these maladies, sero-enter-
itis occasionally supervenes, either alone, or
in connexion with peritonitis.

56. Enteritis may also occur as a complica-
tion of the advanced stages of measles, more es-
pecially upon the premature, or the regular de-
cline of the eruption ; but it is generally slij^ht
in degree, and rarely the cause of an unfavour-
able termination of that disease, unless when
associated with general bronchitis, or with pneu-
moma. In some of such cases, the inflamma-
tion has been found affecting the villous sur-
face of the intestines to a considerable extent,
the mucous follicles and the mesenteric glands
being enlarged or inflamed. There are other
contingent complications of enteritis, as those
with splenitis, with peritonitis, &c. ; but they re-
quire no particular notice at this place, having
been noticed under those heads.

57. In children, the different forms of enter-
itis appear more frequently associated with
other diseases than in uncomplicated states ;
for they seldom continue long in those latter
states without superinducing other disorders.
In many instances the complication is either
accidental or contingent ; in others, it depends
upon the nature of the predisposing and exci-
ting causes ; while in some, the associated dis-
eases arise as consequences of the primary af-
fection of the intestinal canal. Sufficient allu-
sion has already been made to these complica-
tions ; the most important are, infantile remit-
tent fevers, cerebral congestions, &c., bron-
chial affections, tubercles, disease of the mes-
enteric glands, &c. It is not unusual to ob-
serve, particularly in some seasons, a form of
fever very prevalent, or even epidemic among
children, in which both the digestive and the
respiratory mucous surfaces are aflected by a ca-
tarrhal form of inflammation, and in which the
state of irritation seems to predominate in these
surfaces above that of true inflammatory action.
In many of these cases, it is difficult to deter-
mine whether the digestive canal or the respi-
ratory organs are first affected ; either may ex-
perience a priority, or predominance, of disor-
der ; and the one may become free from disease
as the other is more severely affected. These
circumstances are of great imjiortance in the
management of this complication, which is ex-

INTESTINES — Inflammation op— Diagnobis.

671

tremcly frequent in infants and children in Lon-
don, particularly in the poorer classes and in
children insufficiently or improperly nourished
and clothed.

58. V. Diagnosis. — Little need be added on
this subject, as much has already been stated
in reference to it ; and as, both in pathological
and in therapeutical points of view, it is as ne-
cessary to point out relations, approximations,
or alliances, between diseases, as to assign dis-
tinctions between them; that exist only in the
more extremely removed cases, and that cannot
be detected in the majority of instances, or only
partially, and in their slighter or finer shades.
Writers, who had little knowledge of disease
from close personal observation, have been in
the habit of stating certain distinctions between
allied affections of the digestive canal, as if they
were describing different genera, or distinct
substances in natural history, or certain un-
varying entities, or algebraic quantities ; and
hence misleading, more frequently than in-
structing, the inexperienced. The disorders
which they have thus endeavoured to distin-
guish from the different varieties of enteritis,
or, rather, from enteritis simply, as they have
known but little of its various forms and as-
sociations, are colic, ileus, gastritis, peritonitis,
constipation, diarrhoea, cholera, and dysentery ;
and it must be obvious to the scientific and ra-
tional practitioner, that it is quite as important
for him to trace the connexions between diseas-
es, and the transitions of the one into the oth-
er, as to recognise differences, which are often
more apparent than real, and which should be
estimated as they truly exist — as modifications
rather than differences — as indications of some-
thing in common, but as something also pecu-
liar or proper to each, which it is necessary
thus to establish.

59. A. There are certain circumstances con-
nected with the seats of enteritis to which
some reference may be made, as being not
without importance in practice ; and these may
be comprised in an answer to the following
question : How far may the symptoms enable us
to conclude as to what portion of the intestinal ca-
nal is chiefly or solely affected ? Before any con-
clusion should be arrived at, the exact seat of
pain, the part in which it commenced, the seat
of tenderness or distention ; the state of the
stomach and bowels, and the periods after ta-
king food when vomiting or purging occur ; the
sounds and sensations caused by percussion ;
the appearance of the evacuations ; and the na-
ture of the exciting causes, should be duly con-
sidered. — a. Tlie scat of pain at the commence-
ment of the attack is always deserving of at-
tention, as indicating, although not always cor-
rectly, the part affected. If the disease begin
in the region of the duodenum, or if this part be-
come consecutively affected, irritability of the
stomach a very short time after food is taken,
and either increased or interrupted discharge
of the bile, are more likely to occur, and the
calls to stool are not nearly so frequent as when
the lower portions of the bowels are inflamed.
(See Duodenum, ^ 7, ct scq.) When pain, ten-
derness, and fulness commence around the na-
vel, or between it and the right ilium, inflam-
mation of the ilium may be suspected ; and if
there be diarrhoea, and pain in the region of the
cacum, the pains assuming a colicky or griping

character, and extending in the course of the
colon, the extension of the disease to these vis-
cera may be inferred, especially if tenderness
exist in these situations, if there be little or no
vomiting, and if the symptoms be exasperated
two or three hours after a meal. When inflam-
mation of the villous surface of the colon is
sub-acute or chronic, even although it impli-
cate the lower part of the ilium, or when chron-
ic ilio colitis is present, the functions of the
stomach are often but little affected, unless the
attendant diarrhoea is suddenly arrested, or
constipation occur. It is chiefly at the com-
mencement, or during the early stages of in-
flammation, that it is limited to one portion of
intestine, or to a single tissue. The rapidity
of extension of the disease to adjoining parts
is generally great in proportion to the depres-
sion of vital power, the state of this power in
connexion with that of the blood giving rise to
the particular form or character of the inflam-
mation, and of its consequences or products.

60. b. A serous state of the stools, particular-
ly if albuminous flocculi, or pieces of lymph, be
contained in them, show that the villous mem-
brane is chiefly affected ; while a mucous, or
muco-puriform condition of them indicates dis-
ease of the follicular glands : a combination of
these two states suggests the probable associ-
ation of these affections. The presence of di-
gested fcecal matters in the stools, duly colour-
ed with bile, evinces the performance of the
functions of the upper portions of the alimenta-
ry canal ; but when the food is imperfectly
changed, impairment of these functions, and
great irritability of the muscular coat, owing to
general and local debility, and disease of the
mucous surface, may be inferred ; the inflam-
matory irritation generally extending, in such
cases, to both the small and large intestines.
If the stools are devoid of their peculiar or
usual odour, the large bowels are probably af-
fected. If they contain small but numerous
streaks of blood, or if the blood be mixed in
small quantity with the other matters, a severe
form of muco-enteritis is generally present. If
the blood be passed in larger quantities ; if it be
mixed with the other evacuated matters ; or if
it be grumous, or muco-puriform matter be
also observed, ulceration consequent upon fol-
licular enteritis is usually found. If it be void-
ed quite pure, in large quantity, and but little
mixed with the rest of the motion, it common-
ly proceeds from the large bowels.

61. c. Percussion should seldom be omitted
in endeavouring to ascertain the seat of enter-

I itis. It can rarely be endured when, or in situ-
I ations where, the inflammation has advanced to
i the serous coat. It assists in indicating the
parts most distended by flatus, or obstructed by
faecal accumulations, by internal strangulation,
or by adhesions, or thickening, &c., of the coats
of the bowel. As long as the disease is con-
fined to the inner surface, it seldom causes
much pain at the time, although soreness, or
aching, is usually increased by it afterward.

62. d. Among other circumstances contribu-
ting to a correct diagnosis of the several forms
and complications of enteritis, the nature of the
causes, the constitution and the previous health
of the patient, are not the least material, par-
ticularly as respects the character of the at-
tendant fever, and of the local affection. If

672

INTESTINES— Inflammation of— Diagnosis.

these causes are of a septic, contaminating, or
depressing kind, such as aheady enumerated
(<5i 18), the mucous follicles will be especially
affected, and the fever will present the adynam-
ic state. If the powers of life have been pre-
viously sunk, or if the circulating fluids have
become morbid or contaminated, or if there
have been manifest cachexia conjoined with
great debility, the local and the constitutional
affections will be such as just stated ; and both
the small and the large bowels will be similar-
ly and almost coetaneously affected. When
inflammation in these cases advances to the
serous surface, particularly after perforation
of the coats, it extends rapidly over this sur-
face, and gives rise to a more or less copious
fluid effusion, the state of local as well as of con-
stitutional action being, in such circumstances,
rarely capable of producing coagulable lymph,
as shown in the article Inflammation {^ 58.)

63. B. If it be necessary to ascertain the
parts of the intestines which are the seats of
inflammation, it is still more requisite to deter-
mine ivhcther or not inflammation is really present.
This, however, is not always so easy as many
have believed ; for inflammatory action may
exist in the digestive canal, so as to give rise
to many of its most dangerous results, without
those symptoms by which inflammation has
generally been supposed to be indicated hav-
ing been observed. Several of these disorders,
usually viewed as functional merely, and which
undoubtedly are sueh in many, or even in the
majority of cases, often proceed from inflam-
matory action in a portion of the villous sur-
face, that either extends itself in a gradual or
rapid manner, or becomes resolved when the
causes have ceased to act, or when the secre-
tions from the part have had the effect of re-
moving the irritation, or of unloading the con-
gested and inflained vessels. Many cases
which have been viewed, from the character
of the prominent symptoms, as flatulence, or
constipation, or colic, or diarrhoea, have actual-
ly been some form or other of enteritis, or in-
flammatory states, in which certain portions of
thfi intestines, or of the tissues composing their
parietes, have been affected in a different man-
ner, or in a modified form or degree.

64. a. Flatulence, constipation, and colic are
chiefly functional disorders of the digestive ca-
nal ; but they often depend upon inflammatory
irritation of some portion of it, and are apt in-
sensibly to pass into inflammation. They,
moreover, both severally and conjointly accom-
pany, as prominent and important symptoms,
the most severe and dangerous forms of enteri-
tis. Hence the necessity of determining their
sources, and their connexions with, or inde-
pendence of inflammatory action. If the least
tenderness or soreness on percussion, or on
firm pressure of the abdomen, be felt or indica-
ted ; if this examination soon afterward occa-
sion soreness, pain, or uneasiness internally,
although neither may have been complained of
at the time of making it ; if the pulse be harcT,
constricted, or full, or accelerated ; if the ab-
domen become tumid or tense, dry, liot, or
harsh ; if the tongue be white, the papilla? erect,
and its point or edges red ; and more especial-
ly if nausea or vomiting occur, the connexion
of either of these affections with, or their de-
pendance uoon incipient or developed inflam-

mation, should be inferred, and a strictly anti-
phlogistic treatment prescribed. I have met
with instances where enteritis had been treat-
ed as simple constipation with colicky pains,
and where the slightness of the above symp-
toms, or the presence of only one or two of
them, had deceived the inexperienced practi-
tioner into the exhibition of acrid and heating
purgatives, which had aggravated the disease
until it had proceeded too far to be arrested by
the most judicious means, fatal symptoms sud-
denly appearing, and the patient sinking before
the mischief was anticipated.

65. b. Ileus, like the preceding affections,
may or may not be associated with, or be en-
tirely owing to inflammation. It is shown in
the article on Colic and Ileus (^ 37^5), that these
affections are often thus related, the latter par-
ticularly ; and that, even when depending upon
the pathological states there enumerated, in-
flammation is very often either an associated
or a superinduced lesion, generally implicating
all the coats of a portion of intestine, or the
serous coat more especially. In many of these
cases, either some internal constriction, or
strangulated hernia, or an intus-susception, is
the cause of suffering ; but in these, as well as
in those originating differently, inflammation
soon supervenes, although it is not always an-
nounced by rigours or consequent reaction, or
even by the general character of the symptoms.
Indeed, the sufferings of the patient are fre-
quently so great, and the vital power is so ex-
hausted by the nature or extent of the lesion
— the shock sustained by the constitution is
such — as to prevent the development of the
phenomena of general vascular reaction, and
to extinguish life before the local changes char-
acteristic of inflammation had proceeded far,
or before symptomatic fever had supervened.
These attacks, and particularly those varieties
of colic usually denominated the Lead, and the
Madrid colic {§ 16. 25), have been viewed as
forms of cnteralgia merely, or of neuralgia of
the intestines, and described as such by sever-
al Continental writers. That the sensibility
of the nerves of the intestines is morbidly ex-
cited or affected, will be admitted ; but that
these diseases consist only of altered sensibil-
ity, cannot be conceded. This is a part, mere-
ly, of the pathological states constituting these
maladies ; impaired and disordered secretion
and excretion, a morbid condition of all the se-
cretions poured into tiie intestinal canal, and
diseased action of the muscular coats of the
bowels, equally form a part, and often the most
important and efficient part of them, various
other associated functional derangements being
also present.

6G. c. Dmrrhosa, Cholera, and Dysentery may
be associated with intestinal inflammation, or
may pass into it ; and, equally with the fore-
going disorders, require to be carefully distin-
guished in their simple and in their sympto-
matic or complicated states. — a. Diarrhoea, par-
ticularly its serous and mucous forms, has been
already shown to be one of the earliest indica-
tions of enteritis, particularly when the mucous
coat and follicles of the small and large intes-
tines are the tissues affected. But the slighter
and more evanescent states of diarrhcEa are
generally independent of inflammation, and
proceed chiefly from irritation and increased

INTESTINES — Inflammation of — Terminations of, and Prognosis.

673

exhalation and secretion, caused either by the
nature of the ingesta, or by checived cutaneous
and puhnonary transpiration, or by the state of
the secretions poured into tlic digestive canal ;
tlie irritation and increased secretion, howev-
er, often passing into inflammatory action
whenever a predisposition to it is present. As
soon as this change takes place, the states of
the stools, of the abdomen, of the skin, of the
pulse, and of the tongue, as described above (<)
7, ct seq.), will generally indicate it to the care-
ful observer.

67. li. The same observations apply to Chol-
era, which also may pass into enteritis ; but it
should be recollected that when inuco-enteritis
in an intense form is seated chiefly in tlie duo-
denum and jejunum, that the symptoms may
nearly approach those of cholera ; vomiting,
diarrhcea, and sympathetic spasms of the mus-
cles of the extremities, being often as severe in
this state and seat of enteritis as in that dis-
ease. It has already been shown that bilious
cholera (i) 25) sometimes passes into enteritis ;
tiie irritation of morbid or acrid bile exciting
inflammatory action in the mucous surface, that
either subsides without proceeding farther than
this surface, or extends to the external coats
when the inflammatory disposition is consider-
able. In either case, particularly in the latter,
the physician will he guided by the symptoms
evinced by the parts and in the manner already
named {^ 59) in forming his diagnosis.

68. y. In Dysentery, more or less inflamma-
tory action of the mucous surface and follicular
glands of the large intestines is generally pres-
ent, especially in the sthenic forms, and in the
developed states of the disease. Still, the in-
flammation is often a superinduced and an as-
sociated, rather than a primary morbid condition
in this malady, the abdominal secretions and
excretions being the first disordered.* These
secretions irritate the mucous surface and its
follicular apparatus, and induce inordinate or
spasmodic action of the muscular coats of the
bowel, and particularly of the rectum and
sphincter ani, causing the retention of the more
hardened portions of faeces, which farther aug-
ments the irritation, until inflammation, with its
various consequences, is produced. In such
cases, it is not merely the existence and the
e.vact seat of inflammation that should be as-
certained, and which the description already
given will generally indicate ; but the charac-
ters of the local action and of the constitution-
al affection ought also to be closely observed
and correctly estimated.

69. d. When inflammation extends to the se-
rous coat of the intestines, it becomes identified
with pcntomtis ; and whether it be limited to a
small portion of this coat, or extend more or less
generally, it is in all respects an intestinal per-
itonitis, of the diagnosis of which sufficient no-
tice is taken under that head (see Peritonf,um),
to which, and to the article Stomach, where
enteritis is distinguished from gastritis, the
reader is referred for farther remarks on the
diagnosis of these very intimately-related mal-
adies.

* [We believe that the increased secretions and excre-
tions in the first, or forming stage of dysentery, are the con-
sequences of the inflammatory congestion of the vessels of
the mucous tissue, and that any other pathology must ne-
cessarily lead to erroneous practice .]
II 85

70. c. As the complications of enteritis are so
important, it becomes requisite that the diag-
nosis of them, and even the successions of their
appearance should not be overlooked. This is
still more important in warm climates, where
enteritis is very often a complicated malady.
When functional and org<imc diseases of the liv-
er are attended by a morbid secretion of bile,
or when this fluid has become acrid, enteritis
is very commonly induced in on« or other of its
forms, and is then rarely limited to the small
intestines, the colon and rectum being often
implicated, and hepatic dysentery developed.
But chronic enteritis, or ileo-colitis, may occa-
sion, as already shown {() 49), disease of the
liver, particularly of its internal structure, ei-
ther with or without purulent formations in it.
In this case, increased frequency of vomiting,
tenderness and fulness in the right hypochon-
drium and epigastrium, chills, rigours, and
jaundice, may supervene, and indicate the na-
ture of the complication, or they may be almost
or entirely absent. In warm climates, enteri-
tis, hepatitis, and dysentery are often associa-
ted, and without sufficient proof being furnish-
ed of their course of succession. In the East-
ern hemisphere, however, the disease of the
liver is most frequently the primary affection,
although it sometimes is induced by either, or
by both of the other maladies. Of the compli-
cation with gastritis, it is unnecessary to add
more than that its existence should always be
expected when enteritis is occasioned by stim-
ulating, acrid, or poisonous ingesta, or by an
excessive quantity of rich and heating food or
drink. In these cases, the frequency af the
vomiting, the recurrence of it instantly after
substances are taken into the stomach, the
constant or frequent eructations of flatus, the
epigastric tenderness, soreness, pain, and ful-
ness, in addition to the symptoms of enteritis,
will indicate the morbid association. When
this complication arises from the nature or the
quantity of the ingesta, the affection of the
stomach sometimes subsides as that of the
small or large bowels increases, and thus gas-
tro-enteritis may p-ass into muco-enteritis, and
thence into ileo-colitis or dysentery. This
succession is not infrequent in warm climates,
or in temperate climates in summer and au-
tumn, and particularly in those who have par-
taken of unwholesome food, or who have ex-
ceeded in the use of spirituous or fermented
liquors. Enteritis in connexion with gout, or
in the gouty diathesis, and especially upon the
disappearance of gout from the extremities, is
not uncommon, and is always sudden and se-
vere in its occurrence ; but farther allusion
will be made to it hereafter.

71. VI. Terminations or Consequences and
Prognosis. — A. A. favourable termination of en-
teritis is indicated by a diminished severity of
the more prominent symptoms, by the decrease
of fever, by a more natural state of the evacua-
tions as to their appearance and their frequen-
cy, by a more copious discharge of urine, by a
more clean, moist, and natural state of the
tongue, by a less frequent pulse, and by a dim-
inution of the tenderness, soreness, fulness,
tension, and heat of the abdomen, the general
surface becoming more moist and natural.

72. B. The luifavourable consequences or ter-
minations of inflanrmiation of the bowels are,

674

INTESTINES— Inflammation of— Lesions.

1st. Ulceration, with its consequences, intes-
tinal haemorrhage, or perforation of the intes-
tines ; 2d. Various organic lesions of the coats
of the intestines and of the mesenteric glands ;
3d. Peritonitis in some one or other of its
forms ; 4th. Exhaustion of, or fatal shock to
the vital powers ; and, 5th. Sphacelation of a
portion of the intestinal tissues or parietes. —
a. Ulceration of the intestines is not necessari-
ly a fatal lesion, although it is so with few ex-
ceptions ; for ulcers have been found cicatrized
in this situation, the patient having died of
some other disease which had occurred long
subsequently to the intestinal affection. These
cicatrices very rarely present any regeneration
of the villous tissue, although this has been ob-
served by M. Andral. Their bottoms consist
of a cellulo-serous tissue, of a grayish white,
without either villi or follicular glands, gradu-
ally assuming the appearance of the surround-
ing mucous coat, and possessing considerable
firmness and tenacity. Ulceration of the intes-
tines — which is fully described in all its forms
in the article Digestive Canal (9 36-40) — is
not satisfactorily indicated by symptoms ; al-
though a combination of phenomena may lead
to a just conclusion as to its presence. A mu-
co-puriform or ochrey appearance of the stools,
an increased frequency of them, the presence
of large quantities of blood in them, and symp-
tomatic fever assuming an adynamic or chronic
remittent, or hectic form, are the surest indi-
cations of ulceration. The diarrhoea appearing
in the course of tubercular disease is generally
dependant upon, or connected with disease of
the follicular glands, and, at an advanced stage,
with ulceration. Whenever muco-enteritis or
follicular enteritis occurs in the course of a
constitutional malady or vice — of fever, of tu-
bercles, or of general cachexia, the rapid super-
vention of ulceration may be anticipated.

73. b. Various organic lesions of the parietes
of the intestines, similar to those about to be
noticed, or more fully described in the article
Digestive Canal (^ 25, et seq.), and of the mes-
enteric glands, may be occasioned by enteritis,
the patient continuing for months or years sub-
sequently to evince disorder of the sensibility
or functions of the bowels. These lesions,
particularly dilatations, contractions, thicken-
ing of the coats, &c., according as they influ-
ence the caliber, or the secretions, or the con-
tractility, or the organic sensibility of the intes-
tines, occasion flatulence, constipation, colic,
indigestion, retchings, emaciation, facal accu-
mulations, hypochondriasis, and various ner-
vous complaints, and, at last, either an attack
of inflammation of the bowels, or of one of the
associated viscera, or some other malady, car-
ries off the patient.

74. c. Fcritonitis, whether circumscribed or
general, takes place in two ways : from ulcera-
tion, and from the extension of the inflammation
to the serous coat without ulceration. It may
arise from ulceration without perforation of this
coat. In this case the peritonitis is usually lim-
ited. If the ulcer have perforated all the coats,
general peritonitis, caused by the effusion of a
portion of the contents of the intestines, com-
monly results. Sometimes, however, perfora-
tion takes place without effusion occurring,
owing to adhesions of the opposing serous sur-
faces having taken place before the coats of the

intestine had been entirely penetrated. This
consequence of enteritis is fully illustrated in
the articles on the Peritoneum and Digestive
Canal {() 40-43), where numerous instances
and references are adduced. The extension
of the inflammation from the internal to the
external surface of the bowel, whether it con-
tin-ue limited to a portion only of the latter, or
extend more generally, is a frequent conse-
quence of enteritis, which is indicated by the
symptoms already enumerated (!) 31), and by
those more fully described when treating of
inflammation of the Peritoneum.

75. d. Exhaustion of, or the shock sustained ly
the vital powers, is more frequently a termina-
tion or consequence of enteritis than sphace-
lation or gangrene. Many of the instances of
death which have been attributed to this latter
change have actually depended upon the former;
but, when sphacelation of a portion of the in-
testine does take place, very nearly the same
symptoms which indicate the one accompany
the other. It is extremely probable, moreover,
that in some of those cases where gangrene of
a portion of intestine is detected after death,
the gangrene had not existed at the moment
of death, or had commenced either then or soon
afterward ; and that the symptoms were those
of vital exhaustion or shock, leading not only
to death, but also to sphacelation of the most
inflamed part, death occurring first, and spha-
celation soon afterward, or both nearly con-
temporaneously ; an opposite course, however,
taking place in rarer cases. When the pulse
becomes very rapid, small, weak, irregular, or
intermittent ; when the breathing is hurried,
laboured, irregular, and attended by increased
action of the nostrils ; when hiccough or regur-
gitation of the contents of the stomach without
retchings occurs ; when the patient complains
of sinking, coldness of the general surface or
of the extremities, or becomes restless ; when
the abdomen is tympanitic without increase of
pain, or the skin is cold and clammy ; and when
the eyes are sunk, surrounded by a dark circle,
and all the features sharp and collapsed, vital
exhaustion, in connexion with more or less of
structural lesion, has then proceeded too far
to admit of hopes of recovery.

76. e. Although gangrene oftener follows im-
mediately upon than precedes dissolution, yet
we sometimes have its existence antecedently
to this issue sufficiently demonstrated. When
the inflammation is caused by strangulation,
and an operation is performed at a too late pe-
riod, the portion of intestines thus circumstan-
ced has been occasionally found in a sphacela-
ted state, although more frequently it is a state
of venous congestion, or a condition about to
pass into sphacelation, rather than this latter
state that is observed. Moreover, in cases of
enteritis caused by intus-susception, a consider-
able portion of intestine has been thrown off in
a gangrenous state. Even portions of the vil-
lous coat of the bowel have been detached by
effusion of fluids underneath it, whereby, its
vascular connexion being destroyed, sphacela-
tion has taken place. In all such cases, the
symptoms of vital exhaustion above enumera-
ted {i) 75) present themselves, and death en-
sues, with very few exceptions. These excep-
tions occur only when adhesions of the oppo-
sing surfaces had formed so as to admit of the

INTESTINES— Appearances after Death.

675

detachment of the sphacelated portion without
effusion of the intestinal contents into the per-
itoneal cavity taking place. Wiien gangrene
precedes dissolution, then, in addition to the
symptoms just noticed, extreme tympanitic dis-
tention of the abdomen, with diminution of the
pain, or complete cessation of pain ; faintness,
breathlessness, syncope on raising the head,
sinkings, cold sweats, and coldness of the sur-
face ; constant hiccough, with flatulent eruc-
tations ; unconscious or unrestrained evacu-
ations, with a putrid or cadaverous odour ;
a small, weak, imperceptible or intermitting
pulse ; collapsed features, sunk eyes, and dis-
coloured surface indicate the disorganization,
and soon terminate in death.

77. VII. Appearances after Death. — I must
refer the reader to the articles on the Digestive
Canal {() 18-43), Diarrhcea (l) 13-23), and Dys-
entery (4 58-60), for a detailed account of the
structural changes consequent upon inflamma-
tions of the intestines, and merely state, at this
place, those more generally observed. When
enteritis or entero-colitis supervenes upon in-
flammation of the stomach or liver — the dis-
ease of these organs occasioning death, and
thus furnishing an occasion of observing the
earlier changes connected with enteritis — the
villous coat is then more vascular and florid
than usual, and more turgescent, particularly
the valvule; conniventes ; and in many places
the mucous glands are more developed, and
marked by a deeper tinge. The appearances
are not uniform throughout the canal, but are
most remarkable in the duodenum and upper
portions of the iUum, when enteritis has been
caused by a morbid state of the bile, or has
been consequent upon gastritis. In these slight
or incipient states, the inflammation is present
only in broad patches or streaks, leaving the
intermediate spaces of a nearly healthy state.
The lowest portion of the ileum, the ileo-caecal
valve, and csecum are oftenest found diseased,
particularly in acute cases, and where enteritis
or entero-colitis occurs as a complication of
febrile drseases.

78. a. In the acute forms of enteritis, the vil-
lous coat is not only more vascular and turgid,
but it is also softer, and sometimes thicker
than natural. If the inflammation lias pro-
ceeded far, it presents a brick-red tinge, and is
easily detached from the subjacent coats, the
connecting cellular tissue being soft, turgid, and
inflamed. When this state exists in a consid-
erable portion of the tube, the coats are appa-
rently thickened, arising from the extension of
the inflammation to the more external tissues,
till the attached surface of the intestinal peri-
toneum is reached. The substance or parietes
of the bowels may be considered as affected
in these cases, even although the external sur-
face may present no farther lesion than red
vessels shooting into it. Occasionally, in ad-
dition to this state, the red capillaries in the
inflamed peritoneal coat are connected with the
effusion of coagulable lymph, particularly in
those parts where they are most numerous,
the lymph or albuminous exudation existing in
specks, or in considerable spots or patches, on
the serous surface. When, however, these lat-
ter appearances are remarked, the interior of
the inflamed intestine frequently presents more
serious changes than yet noticed. The viUous

surface is then deeply inflamed, and seems abra-
ded or excoriated in parts. It is sometimes,
in other parts, covered by patches of lymph, or
of an albumino-puriform or muco-puriform fluid,
or by a sero-sanious matter ; and it is often,
also, ecchymosed in numerous points or specks,
or it presents still larger marks of sanguineous
infiltration. In other cases, portions of a dark,
slate-coloured, or sphacelated hue are observed,
with or without ulcerated specks, or even large
ulcers, which have nearly penetrated as far as
the external coat in adjoining parts. In rarer
instances, one or more of these ulcers have
made their way through the peritoneum, the
contents of the bowel being partly discharged
into the peritoneal cavity. Occasionally, the
ulcer has become attached, at its margin, to an
opposite convolution of the intestines, the es-
cape of fajcal matters into this cavity being
thereby prevented. In a few cases, where the
peritoneal surface has been coated with coagu-
lable lymph, in the progress of the ulcerations
through the membrane, the ulcers have been
covered over by the lymph, so as to prevent the
passage of the intestinal contents through the
perforations. In addition to disease of the fol-
licles, and to the consequences of such disease,
particularly ulceration and perforation of the
intestinal parietes (see Digestive Canal, ^ 37,
40, et seq.), the villous surface, especially after
the forms of enteritis observed in warm climates,
is often excoriated or abraded in parts ; and it
is not infrequently sphacelated in large patches,
particularly in the large bowels. These chan-
ges, however, as well as those consequent upon
chronic enteritis, especially as respects the fol-
licles and glands, are more fully described in
the articles Diarrhcea (^ 12-22), Digestive Cx-
nal (<5i 36), Dysentery (^ 58), and Fever (<J 519).
I shall not, therefore, allude to them farther at
this place.

79. In the forms of enteritis in which the
substance of the intestine or its peritoneal coat
is chiefly affected, either primarily or consecu-
tively, the whole of the coats are often very
vascular, red, or of a brick-red colour, and are
readily torn. Coagulable lymph is effused on
the serous surface, either in distinct clots, or
as a general film, of greater or less thickness,
and gluing the convolutions to each other, and
to the adjoining viscera and surfaces. In these
cases, the omentum has sometimes participated
in the disease, being either more than usually
vascular, or drawn up irregularly to the arch
and flexures of the colon. When the examina-
tion is made within a few hours from death, as
is usual in warm climates, the vascularity of
the diseased parts is very great ; and, although
the colour may be beginning to change, or the
parts to assume a gangrenous appearance, yet
complete gangrene of all the coats of the bow-
el is not often met with. It is, however, com-
mon to find the villous surface apparently spha-
celated in places, and the external coat of the
same part either of a bluish or brownish hue,
but not altogether deprived of its cohesion, al-
though more easily lacerated than usual. In
these acute cases, the inflamed intestine is gen-
erally distended with flatus ; but it is some-
times constricted, and the constricted portions
are occasionally so small as to give the appear-
ance of stricture by the application of a fine lig-
ature. Intro-susceptions of portions of the ile-

676

INTESTINES— Inflammations of— Causes.

um, which liad taken place subsequently to the
occurrence of inflammation, or even just be-
fore, or at the period of death, are met with in
rare instances.

80. b. In chronic cases, as well as in the acute,
the cbanges are chiefly observed either in the
villous surface or in the follicles, or in both.
Many of the lesions observed after the acute
forms of the disease are also met with after the
chronic states. In the latter, however, the villi
are frequently of a blackish tint ; and the iso-
lated follicles and glands are oftener affected
than the agminated glands, which latter are
chiefly attacked in the acute. As respects the
villous coat, the lesions consist of softening,
thickening, and induration ; with various chan-
ges of colour, from the lighter hues to a slate or
deep-brown colour, and even to black. While
softening of the internal coats is most common
in the acute, hardening of these parts is most
frequent in the chronic states of the disease.
With the thickening of the villous and connect-
ing cellular tissues there is sometimes a very
remarkable contraction of the bowel ; and
many of the alterations described in the article
Digestive Canal {ij 26-31, 52, et seq.). As re-
spects the changes of the follicles and glands,
I can add but little to what I have stated in
this and the other places already referred to.

81. c. The ulccraiwns which take place in this
form of the disease assume three different"
forms : 1st. Those which commence in the ag-
minated, or Peyer's glands, and are seated lon-
gitudinally in the intestine ; 2d Those which
originate in the isolated follicles and glands,
and are of a rounded form ; and, 3d. Those
which attack the villous surface, and present
a transverse direction as respects the canal of
the bowel. Either of these may go on to per-
foration, and the production of acute or chronic
peritonitis. Occasionally, tubercular matter is
detected at the margins of the ulcers. The
mesenteric glands are often enlarged, inflamed,
or congested, softened, and even suppurated.

82. d. I have had no opportunity of observing
the appearances after death in the chronic ca-
ses where membranous or tubular exudations
have been voided from the intestines, but such
appearances have been observed by several au-
thors. Dr. Monro states, that when the vil-
lous coat of the intestines is inflamed, the di-
ameter of the part is much diminished by the
effusion of coagulable lymph upon this coat ;
that the quantity of lymph is very various,
sometimes being as thin as a wafer, at other
times nearly filling the affected bowel ; and
that occasionally it forms only a thin lining to
the villous coat, or appears in the form of tat-
tered shreds, in some cases filling the spaces
between the valvulae conniventes, in others,
covering these. In a case described by M. Pail-
Loux, the villous coat was covered by a mem-
branous layer, extending uniformly over its sur-
face. The follicles did not seem to have any
share in the production of this membrane, which
lie considered as differing o.nly by its continuity
and thickness from the small isolated patches
secreted by the villi in aphthous affections.
According to the appearances observed by MM.
Billard and Lalut, these tubular exudations
and false membranes arc produced from the
villous surface itself, and not from the mucus
secreted by the follicles, or from a diseased ac-

tion of these follicles. These exudations have
been observed in all parts of the alimentary
canal.

83. c. In the acute and chronic forms of enter-
itis, inflammation of portions of the mesentery
is sometimes observed, either with or without
disease of the glands ; and an oedemalous state
of this part is occasionally met with. Other
changes are more rarely remarked, both in the
small and in the larger intestines ; but they
are merely incidental, and are described in the
places above referred to. Various alterations
are often, also, observed in the related viscera ;
but these are accidental complications, which
need not be adduced at this place.

84. VIII. Causes of Inflammations of the
Intestines. — i. Predisposing. — The several va-
rieties of enteritis occur at all ages, in all tem-
peraments, and in both sexes ; but they are
most frequent in infants during the first denti-
tion, and soon after weaning; and in the ner-
vous, irritable, and sanguine temperaments.
They are occasionally more prevalent in some
families than in others, owing to peculiarity of
constitution, and have hence assumed, in a few
instances, somewhat of an hereditary charac-
ter, especially in their slighter forms. Both
sexes are nearly equally liable to them ; males
being, however, rather more frequently attack-
ed than females, probably in consequence of
their greater exposure to the exciting causes.
The several forms of the disease may assume,
from states of season and weather, or from the
constitution of the air, a more or less epidemic
prevalence. They are most common in warm
and humid seasons, and when the vicissitudes
of temperature are sudden and great; hence
they are more frequent in autumn and summer
than in other seasons, and when cold nights
succeed to warm or hot days. They are also
almost endemic in some countries, partly owing
to the high range and high daily vicissitudes
of the temperature, in connexion with great
humidity of the atmosphere ; but partly, also,
owing to the low and miasmatous state of the
locality, or to the circumstances connected
with the supply of water. Inflammations of
the bowels of an asthenic form, often assuming
the characters of dysentery, or chronic diar-
rhcea, or chronic ileo-colitis, or a true follicular
enteritis, are very commonly caused, in hot
climates, and even in numerous places without
the tropics, by water preserved in tanks, or ta-
ken from marshes, or abounding with animal
exuviae or animalcules.

85. ii. The exciting causes of enteritis may
be divided into, 1st. Those which operate di-
rectly on the digestive villous surface ; 2d.
Those which act indirectly, by arresting the se-
cretions and excretions, and by determining the
momentum of the circulation to the intestinal
mucous membrane ; 3d. Those which act me-
chanically, as strangulations, injuries, wounds,
&c. ; and, 4tli. Those which act sympathetical-
ly. — A. The causes acting directly upon the bow-
els are the ingesta, whether alimentary, medi-
cinal, or poisonous. — a. The food often occa-
sions enteritis, gastro-enteritis, or entero-coli-
tis, by its quality, quantity, variety, and incon-
gruity. Heating, stimulating, or rich food,
especially in great quantity, frequently produces
muco enteritis, and its several consequences
and complications ; while food which is ua-

INTESTINES— Inflammations of— Causes.

677

wholesome, septic, putrid, imperfectly pre-
served, or mouldy, or spoiled, or innutritious,
generally occasions follicular enteritis, or en-
tero-colilis, or dysentery. Too great a quanti-
ty of food, or incongruous or indigestible food,
particularly after prolonged abstinence or fast-
ing, is a frequent cause of the more acute forms
of enteritis. Thus a quantity of cheese eaten
in these circumstances has, in several instances
which I have observed in the course of my
practice, produced this effect. Among the ali-
mentary substances most productive of enter-
itis, smoked, dried, and long-preserved meats,
pork, ham, bacon, cheese, stale fish, and high-
seasoned dishes, may be particularized.

86. b. The inordinate use of spirituous or
other intoxicating liquors is among the most
common causes in the lower classes, particu-
larly in hot climates and in warm seasons.
Even a small quantity of spirits taken by per-
sons unaccustomed to them, and during disor-
ders of irritation affecting the alimentary canal,
will often develop a state of inflammatory ac-
tioii. Unripe or stale fruit ; too large a quanti-
ty of fruit or of vegetables ; most acid and cold
fruits, and particularly pineapples, melons, and
cucumbers -, cold fluids or ices taken while the
body is perspiring, or very soon after, or imme-
diately upon a meal ; and acidulated beverages,
or cider, perry, &c., often occasion either en-
teritis, or some one of the disorders of the di-
gestive organs, most apt to pass into, or to be as-
sociated with this disease. The changes which
the ingesta undergo in the stomach and bcrwels,
especially when excessive in quantity or varie-
ty, or otherwise incongruous, and when imper-
fectly changed with the gastric juice and bile,
give rise to enteritis, either directly, or consec-
utively to indigestion, costiveness, colic, or
diarrhoea. The influence of the secretions,
particularly of the bile, when redundant or ac-
rid from the changes consequent upon inter-
rupted excretion of it, in giving rise to ileo-oo-
litis, has already been insisted upon.

87. c. The frequency of the several forms
of enteritis in young children, particularly in-
fants brought up by hand, or after weaning, is
caused chiefly by the inappropriate or too
abundant supply of food in these circumstan-
ces. The digestive organs cannot dispose of
the food, either from its quality or quantity, and
the undigested part irritates the digestive vil-
lous surface, or undergoes changes producing
the same effect. In some instances, the disease,
especially the follicular variety of it, is caused
by the insufficient quantity of aliment obtained
from the food, owing to its unsuitableness to
this early period of life, this cause combining
with the irritation produced by the undigested
portion. The milk, also, of some nurses, ow-
ing to the state of their health, and of their di-
gestive organs, or to their habits, especially
in resorting to spirituous liquors, occasionally
gives rise to enteritis, or gastro-interitis, in the
infants suckled by them.

88. The influence of an innutritious and fluid
diet in causing muco-enteritis and follicular en-
teritis, the latter especially, particularly when
aided by cold and humidity, or by miasmata, or
by foul or unwholesome water, has been too
much overlooked. A starving diet and regi-
men not infrequently develop these forms of
the disease in an asthenic form, or in the guise

of chronic diarrhoea or chronic dysentery, par-
ticularly in persons previously accustomed to
live fully or intemperately ; and if these dis-
orders prevail in a number of persons, either
crowded together or shut up in ill-ventilated
apartments, adynamic or typhoid fevers will be
generated, complicated with the enteric dis-
ease. The influence of stagnant and foul wa-
ter, more especially water long shut up in wood-
en casks, and river or canal water, containing
animal matter or impurities conveyed by the
sewers running from cities or large towns, in
producing follicular enteritis, is much greater
than is generally supposed. The use of im-
pure water favours the production of the dis-
ease, when other causes arc in operation, and
imparts a specific, generally an asthenic, char-
acter to the malady. It has the effect of a slow
poison, and acts on the economy, not merely by
impairing the tone of the organic nerves and
villous surface of the bowels, but also by con-
taminating the circulating fluids, and thereby
producing not only a local, but a constitutional
disease at the same time. In this disease, the
general and local asthenia is more prominent
than inflammatory action, which is limited to
the intestinal glands and follicles, and is often
characterized by a tendency to ulceration or
disorganization rather than to reparation.

89. d. Medicinal substances, particularly acrid
purgatives, stimulants, and tonics, injudiciously
resorted to, are more frequently the causes of
enteritis than is commonly supposed, the ef-
fects of these medicines being often mistaken
for the natural course of the disease. Acrid
purgatives, given with the view of removing
indigestion, colic, or constipation, and injudi-
ciously repeated, in circumstances requiring
milder means, have often converted these com-
plaints into acute enteritis, or have aggravated
inflammation where it already existed. Stim-
ulants and tonics, prescribed with the view of
removing debility, and the various forms of in-
digestion, have likewise developed a latent in-
flammation, or changed slight inflammatory ac-
tion, giving rise to symptoms mistaken for
those of debility merely, to acute enteritis, or
to gastro-enteritis. I am, moreover, convin-
ced, from personal observation, during an ear-
ly part of my experience, when I had opportu-
nities, in different climates, of observing, with-
out interfering with the practice of medical of-
ficers in charge of hospitals, and from the pe-
rusal of the journals kept by others, that nu-
merous cases of diarrhoea, and still more of
dysentery, have been aggravated into the most
acute forms of enteritis or of entero-colitis, by
the repeated, continued, and extravagant exhi-
bition of acrid or heating cathartics. I have
in my possession hundreds of cases of these
diseases, written by the medical men who
treated them, in all of which the usual phe-
nomena of inflammation, when seated in the
villous surface of the intestines, and attended
by morbid action of the muscular coats, were
viewed as the consequences of the accumula-
tion and retention of morbid secretions and
fa^al matters, and treated by large doses of
cathartics, prescribed not daily only, but at in-
tervals of a few hours, and thus persisted in
until the dissolution which they either caused
or accelerated took place. The fire once kin-
dled, however slightly or weakly burning, was

678

INTESTINES— Inflammations of— Causes.

thus fanned to a blaze, which soon extinguish-
ed itself in fatal disorganization. A slight di-
arrhoea or simple dysentery, arising from irri-
tation or determination to the intestinal villous
surface, has been converted, by a continued
use of the most drastic purges, into inflamma-
tion, which, in its turn, has been urged on by
the same agents to fatal sero-enteritis and per-
itonitis, with sphacelation of the villous coat.

[We believe that the pathological conditions
of the intestinal canal above described are oft-
ener brought on, in this country, by the gen-
eral prevalence of polypharmacy, or over-drug-
ging, than by all other causes combined. It is
impossible to calculate the amount of mis-
chief thus annually produced by the use of dras-
tic pills, patented by government, as it would
seem, for the special purpose of preventing too
great increase of the population. Physicians
are beginning to learn that diseases are not
cured by drugs, but by nature ; and that harsh,
perturbating treatment, especially such as irri-
tates the tract of the intestinal canal, is gener-
ally far worse than no treatment at all. If ho-
moeopathy had done no more than demonstrate
the curability of most diseases when left to the
unaided efforts of nature alone, it would be en-
titled to the gratitude of mankind ; and this it
has done beyond all controversy.]

90. e. Poisonous svhstanccs are among the
mo6t common causes of enteritis, but generally
complicated with gastritis — of gastro-enteritis.
Some poisons, however, pass into the bowels
from the stomach, without affecting the latter
in a very sensible manner. Most of the min-
eral poisons, and of the acrid and acro-narcotic
poisons, inflame the mucous surface of the in-
testines ; and when they fail of producing fatal
results by the intensity and the extent of in-
flammation, by their injurious impression on the
organic nervous influence, and by the change
they produce in the blood — by these effects, in-
dividually and conjointly — they are generally
the cause of a severe, and often prolonged form
of enteritis, which, however, differs materially,
in its precise seat, and in its characters, ac-
cording to the particular agent which excited
it. (See article Poisons.)

91. B. Those causes ivhich act indirectly, and
chiefly by suppressing accustomed secretions
or excretions, and by determining the momen-
tum of the circulation upon the abdominal vis-
cera, are exposures to sudden vicissitudes of
temperature, especially in connexion with hu-
midity and the influence of malaria ; sleeping
in damp beds or clothes, or in exposed places,
or on the ground during campaigns ; the ab-
straction of the animal heat from the feet, the
loins, and abdomen ; unusual heat applied to
the back and loins ; and the drying up, the sup-
pression, or the disappearance, of accustomed
discharges, evacuations, or eruptions. Enteri-
tis is often caused by the suppression of an ac-
customed perspiration of the feet. Sleeping on
the ground, or exposed to the night dews, es-
pecially after a debauch or the excessive use
of spirituous liquors, is a very frequent cause
of this disease, and particularly of phlegmonoid
or sero-enteritis and colitis, among soldiers and
sailors, especially in warm or intertropical re-
gions. I have seen instances of the disease
occasioned by sitting with the back to a warm
fire at dinner ; by the suppression of the cata-

menia, and by arresting or preventing the re-
turns of the hemorrhoidal flux, without insti-
tuting such precautionary measures as the cir-
cumstances of the case required. The repulsion
of gout or of rheumatism from the extremities
has, in rarer instances, a similar effect ; and
enteritis, appearing in these circumstances, pre-
sents certain peculiarities, especially in the
gouty diathesis, or when it occurs from the
retrocession of gout from the feet. It is then
always very acute, is attended by intense pain,
and is characterized as much by the extreme
morbid sensibility of the parts affected as by
the severity of the inflammatory action, the for-
mer pathological condition requiring more at-
tention from the physician than even the latter.

93. C. Many of the causes of enteritis are
altogether mecha^iical, and act either internally
or externally, in respect of the canal of the in-
testine. — a. The former consist chiefly of hard-
ened faeces obstructing the tube, or lodged in
the cells of the colon ; concretions of various
kinds ; and the inordinate distention occasioned
by gases or fajcal accumulations. Hardened
faeces and concretions first irritate, and after-
ward inflame the parts in contact with them,
if the muscular action of the coats of the bow-
el fails in procuring their expulsion, and a some-
what similar effect is produced by retained or
accumulated faces and morbid secretions. The
over-distention occasioned by flatus weakens
the coats of the intestines, overcomes their
power of reaction, and favours the suppression
of the natural exhalations and secretions, and
the consequent development of inflammation
in the over-distended part.

93. b. The mechanical causes of enteritis ex
ternal to the canal are hernial strangulations,
and strictures of any kind which diminish the
diameter of the canal ; intus-susceptions, the
pressure of tumours developed within the wall.3
of the abdomen and pelvis, and injuries, wounds,
or operations. Every patient who complains
of the usual symptoms of enteritis, especially
of vomiting and constipation of the bowels,
should undergo a strict examination, in order to
ascertain the existence or non-existence of the
several kinds of hernia. The presence of her-
nia in connexion with enteritis indicates at
once both the nature and cure of the disease ;
but hernia or external strangulation may exist
without the lesion being manifest, or its seat
or cause being detected, or even admitting of
detection, although suspected and carefully in-
quired after ; and the mischief may be caused
by an old hernia, or in connexion with an old
protrusion, which can no longer be detected on
examination. When internal strangulation ex-
ists, the symptoms of ileus, or of acute enter-
itis, or of both in succession, are usually pres-
ent. The seats and causes of strangulation
are so numerous, as shown and described in
the articles on Colic and Ileus {() 37), and Di-
gestive Canal {() 56, 57), that we can but sel-
dom come to a correct conclusion respecting
them, unless they are subjected to our senses,
as in the case of external hernia ; yet we may
occasionally, from a review of antecedent and
concomitant circumstances, draw inferences,
not only as to the existence of internal con-
striction or strangulation, but also as to its
source, that will approximate, although they
may not be altogether the truth. Either of

INTESTINES — Inflammations of — Treatment.

G79

the many causes which I have enumerated, in
the article just referred to, as productive of il-
eus, may also occasion enteritis, the indamma-
tion generally commencing at the point of stric-
ture, or strangulation, and in the peritoneal
coat, and extending thence usually to the dis-
tended portion of intestine above this point,
and to the rest of the tunics.

94. c. hilus-sunccptions produce, as shown at
another place (Colic and Ileus, <J 38, et seq.),
either ileus or enteritis, or both, either coetane-
ously or consecutively. Where enteritis takes
place, it usually proceeds from strangulation of
the intro-suscepted portion of intestine, and as-
sumes a most acute form, the inflammation
generally commencing in the serous coat, im-
plicating the rest of the coats, and sometimes
terminating in gangrene, and even in the dis-
charge of the gangrened portion of the intes-
tine, the canal being preserved by the union of
the edges of the divided intestine. But this
subject is fully described in the place just re-
ferred to, and also in the article Digestive Ca-
nal {^ 54, 55).

95. d. Tumours formed in any part within
the abdomen, may, from the injurious pressure,
or from the irritation occasioned by them, or
from the extension of inflammation from their
surface to the serous coat of the intestines,
give rise to enteritis. Tumours in the omen-
tum, in the ovaria, or connected with the ute-
rus, sometimes cause inflammation in either of
these modes, particularly in the former ; this
effect being the more readily produced when
the tumour is hard, cartilaginous, or osseous ;
or when it is very large, so as to interrupt, by
its size and pressure, the transit of the more
consistent contents of the bowels ; or when an
injury or blow is received upon, or in the vicin-
ity of the tumour. The lymph effused on the
surface of an adjoining viscus will excite in-
flammation in whatever portion of the serous
surface of the bowels with which it may come
in contact ; enteritis thus occasionally appears
c(»nsecutively upon inflammation of adjoining
organs, from the contact of a morbid secretion
chiefly, and not from extension of the inflam-
matory process over a continuous surface. Ex-
ternal injuries and wounds are occasionally
causes of enteritis, particularly of serous or
phlegmonoid enteritis ; and gangrene of the in-
jured and inflamed part sometimes takes place.

96. D. Mucous and follicular enteritis may
occur sympathetically of some severe disease or
extensive injury of external parts. Either of
these varieties may be consequent upon burns
or scalds, or upon erysipelas, or upon disease
of some vital organ. They constitute, the lat-
ter variety especially, the most frequent com-
plication of continued, and even of periodic
fevers, and more particularly of the eruptive
fevers ; and they are often sequelae of these
fevers. My friend, Dr. Abercrombie, of Cape
Town, informed me that, when measles were
lately epidemic at the Cape of Good Hope,
where they were imported after an absence of
upward of thirty years, the great bulk of the
population being, in consequence, susceptible
of their infection, enteritis sometimes occurred
upon the decline of the eruption, but that it
appeared much more frequently during conva-
lescence, or a few days after the patient had
apparently recovered.

97. IX. Treatment. — The indications, as v/eW
as the means of cure, necessarily vary in the
several varieties of enteritis, and in the differ-
ent circumstances in which they present them-
selves. Some reference ought also to be had
to the causes which produce the disease, and
to the state of vital tone or energy, especially
if the complaint appeared in the course, or as
a sequela of any otlier. I shall tlierefore de-
scribe the treatment most appropriate to the
principal forms of the disease, and to the chief
circumstances with which it is usually connect-
ed.

98. i. Muco-cnteritis and vmco-entcro-colilis
differ only in the extent to which the digestive
canal is aflfected in its internal surface, and in
the different portions of this surface, both va-
rieties being the same in their natures and mor-
bid relations. Tiie means of cure are, there-
fore, equally suitable to both. — A. In the slight-
er states of the complaint, and in the less robust
constitutions, local depletions, chiefly by leeches
applied to the abdomen, will be generally requi-
site ; but in strong, young, or plethoric persons,
a moderate or full blood-letting from the arm
should be premised. Immediately afterward,
small doses of calomel, or of blue pill, or of the
hydrargyrum cum creta, the last especially,
should be given with ipecacuanha, or with the
compound ipecacuanha powder, and repeated
every four, five, or six hours. If the bowels
be insufficiently evacuated, and if the stools be
morbid and offensive, mild purgatives, as sweet
oil, castor oil, or both, may be given, and emoll-
ient and aperient enemata administered. After
these have operated satisfactorily, a warm bath
or the semicupium may be resorted to, and
Dover's powder, or the combinations of ipecac-
uanha just mentioned, may be exhibited, so as
to relax the external surface ; and perspiration
may be promoted by suitable diluents and warm
mucilaginous fluids, or by these latter contain-
ing the liquor ammoniae acetatis with the spiri-
tus ajtheris nitrici, and small quantities of the
nitrate of potash. Or these may be taken in
camphor julep, or any other suitable vehicle.
When there is nausea or occasional vomiting,
the medicines containing ipecacuanha may be
laid aside for the latter preparations, which
may be taken in small but frequent doses, in
any emollient or soothing vehicle most grate-
ful to the patient. In such cases, the stomach
and bowels should be quieted, and their func-
tions excited as little as possible until the mor-
bid action has subsided. In mild cases, these
means, aided by a farinaceous, mucilaginous,
and spare diet, will generally be sufficient ; but
in severer attacks, a repetition of the more ac-
tive of these, and the aid of additional reme-
dies, will be requisite.

99. B. When the disease occurs in the most
acute form, particularly among Europeans in
warm or intertropical countries, and as de-
scribed above {i/ 45), a copious blood-letting
ought never to be neglected ; and the antiphlo-
gistic treatment and regimen should be strictly
enforced. In this state of complaint, local de-
pletions will often be requisite, even after blood
has been taken freely from the arm, and will
sometimes require to be repeated. Leeches
may occasionally be applied around the anus,
preferably to any other situation, more espe-
cially when any degree of congestion of the

680

INTESTINES— Inflammations of — Treatment.

liver is suspected. If the attack be attended
by vomiting, and the large intestines seem but
little afTected, calomel or the hydrargyrum cum
creta may be given with opium, and repeated
according to circumstances ; the bowels having
been sufficiently evacuated, and being kept open
by copious oleaginous enemata ; but, if the
stomach be not irritable, after having evacuated
morbid secretions and faecal accumulations, ip-
ecacuanha may be prescribed with opium and
the nitrate of potass, as in the original Dover's
powder, in as large and frequent doses as the
severity of the case may indicate. After de-
pletions have been sufficiently practised, the
warm bath, semicupium, or hot fomentations,
taking care to keep the bed-clothes perfectly
dry, may be allowed. In these cases, as well
as in all the other varieties of enteritis, the
more acute especially, the turpentine fomenta-
tion on the abdomen, or the liniments in the
Appendix (F. 295, et seq.), employed as embro-
cations in this situation by means of warm
flannels, will be found the most serviceable.
As long as evidence is furnished of the pres-
ence of morbid secretions and feecal collections,
the milder mercurials and laxatives or aperients
should be prescribed, and opiates withheld, un-
til the causes of irritation are evacuated. The
safest laxitives or aperients are sweet oil and
castor oil, if they be perfectly fresh ; but if they
be at all rancid, they will greatly increase the
mischief If these means, energetically pur-
sued, do not remove the disease, it generally
passes into the sero-enteric form, or into the
second stage of that form, with marked ex-
haustion ; a very different treatment being then
indicated, although with little hope of success.

100. Upon the whole, the treatment of the
milder forms of muco-enteritis should be near-
ly the same as is recommended for the more
inflammatory varieties of Diarrhcea {(^ 27, 28),
and that of the more acute cases, particularly
when the large bowels are chiefly affected,
ought not materially to differ from what I have
advised for the inflammatory states of Dysen-
tery (iji 82-87) ; and the greater part of what
I have stated in these places altogether applies
to the present subject.

101. C. The Chronic forms of Muco-enteritis,
and of muco-cntero-colitis, require merely a mod-
ification of the above treatment, appropriately
to the age, strength, and vascular states of the
patient. Local depletions are sometimes neces-
sary, also, in these forms of the disease, and
should even be repeated, according to circum-
stances. The chronic state is often owing to
the indulgence of the patient in too much or
too rich and stimulating food. When this is
the case, then a more rigorous diet and regi-
men are requisite. A diet consisting chiefly of
farinaceous and gelatinous substances, of milk,
sugar [we doubt much the propriety of allow-
ing sugar, or any other form of saccharine
matter, in these cases], chicken or veal broth
in small quantities, with rice, &c., warm cloth-
ing, flannels worn next to the skin, warm baths,
and assiduous friction of the surface of the
body, aided by exercise, travelling, and change
of air, will generally be found most beneficial
in these cases. But the disorder may have
somewhat changed its character in passing
from the acute to the chronic form ; a too rig-
orous diet, during the former state, may have

favoured the development of follicular enteri-
tis upon the subsidence of the inflammation of
the villous surface. Consequently, the persist-
ence of a chronic disorder after the acute should
lead to a careful examination of the local and
constitutional symptoms, and of the evacua-
tions ; and if these be marked by asthenia, or
cachexia, the stools being mucous, muco-puri-
form, or ochrey, and the pulse weak and very
quick, the means about to be recommended for
the follicular variety of the disease should be
prescribed.

102. D. In infants and young children — a. the
acute form oi muco-enteritis requires nearly sim-
ilar means to those already prescribed, but with
due reference to their age and their previous
nourishment. For them, local depletions, the
hydrargyrum cum creta, with ipecacuanha in
small doses, or Dover's powder, and the warm
or tepid bath or the semicupium, or stupes or
fomentations, will generally be necessary. For
infants, however, Dover's powder, and all other
preparations containing opium, ought not to be
prescribed ; nor, indeed, should the alvine evac-
uations be suddenly arrested by these or other
means in young children. When the com-
plaint is attended by much irritability of the
stomach, a full dose of calomel will be of ser-
vice, and if the child be not very young, a
smaH dose of opium may be given with it ; and
the bowels, which are usually then costive,
should be moved by emollient laxative enema-
ta. When the stomach is not irritable, and the
bowels are much relaxed, the stools being mor-
bid, I have often found small doses of the bi-
borate of soda taken in honey, or in dill-water
with paregoric elixir and mucilage, of great
service, af^ter calomel or the hydrargyrum cum
creta had been prescribed. In such cases, also,
the warm bath, stupes, and emollient enemata
are very beneficial. In older children, when
the bowels are very irritable, and the stools
contain blood, small doses of the sirup of
poppies, or of paregoric elixir, may be added to
these or to the starch enema, or to an enema
of thin gruel, or of warm water, or of strained
veal or mutton broth ; local depletions having
been resorted to, according as they may have
been indicated, and ipecacuanha or Dover's
powder given in frequent doses. On the other
hand, the bowels ought not to be allowed to be
costive. When children will take sweet oil, it
is the mildest and most suitable aperient in this
disease, and it should always be employed in
laxative enemata. In the more severe cases,
or after local depletions, the warm bath, fo-
mentations, and suitable medicines have been
prescribed without satisfactory results, mus-
tard poultices, or the warm turpentine fomen-
tation may be resorted to, and be kept on the
abdomen until smarting or burfiing heat is pro-
duced. Either of the turpentine liniments in
the Ajrpendix (F. 296, 311) may be employed in
this manner, with the addition of the tincture
of opium, when the stomach or bowels are very
irritable. In grown children, opium with calo-
mel or hydrargyrum cum creta, and with ipe-
cacuanha, or this latter with nitre and opium,
in suitable doses, are the most important rem-
edies, when employed after vascular depletion.
103. b. In the chronic cases of muco-enteritis,
or of entero-colitis in children, repeated small
doses of hydrargyrum cum creta with ipecac-

INTESTINES — Inflammations of — Treatment,

681

uanha, or with Dover's powder, the warm bath,
or fomentations, and, subsequently, bhsters on
the abdomen, if the foregoing means are ineffi-
cient, are generally necessary. But in this state
of the complaint, diet and change of air, espe-
cially to a high and dry locality, are most ben-
eficial. Advantage will be obtained, also, from
the warm bath, followed by frictions of the sur-
face, and the application of a flannel roller round
the abdomen. The bowels should be duly reg-
ulated by means of mild mercurials, rhubarb,
magnesia, or sulphate of potash, or of sweet
oil, castor oil, manna, &c., aided by enemata,
according to the peculiarities of the case. In
other respects, the treatment advised in the
mucous and chronic states of Diarrhoea (ij SO-
BS) should be adopted.

104. c. In both the acute and chronic states
of the complaint, the utmost attention should
be paid to the diet of infants and children.
When there is much irritability of the stomach,
indicating an extension of disorder to the duo-
denum and stomach, endeavours to give food,
or even medicine, are more injurious than ben-
eficial, until the severity of the attack is abated
by local depletions and external means. If a
full dose of calomel, with or without a little cal-
cined magnesia, is retained, as it generally will
be in such cases, nothing ought farther to be
given for two or three hours, when gum-water,
with equal parts of the milk of a healthy nurse
or of asses' milk, or gum-water slightly sweet-
ened, may be administered in small quantity,
one or two tea-spoonfuls being given at a time.
In these cases, no other purgative than calomel
will be retained in the stomach. The bowels
must, therefore, be opened by means of the en-
emata already mentioned. The diet and regi-
men must entirely depend upon the state of the
bowels. If they be relaxed, the milk may be
taken with lime-water. As the acute symp-
toms subside, more nutritious kinds of light
food and farinaceous articles may be allowed.
Chicken-broth, or veal or mutton broth, may be
taken with rice ; and mild tonics, with the alka-
line sub-carbonates and small doses of ipecac-
uanha, should be prescribed when the digestive
functions are much weakened. [In chronic
cases, a little fat salt pork, or bacon, broiled,
will produce the most beneficial effects.] The
means so fully insisted upon in the several
forms of DiARKHtEA (see more particularly ()
35-52) may severally be employed, according
to the peculiarities of individual cases. In the
sub-acute and chronic states of the disease,
particularly in recently weaned children, or in
infants that are attempted to be reared by hand,
the kinds of milk just mentioned may be given,
immediately upon being drmvn, either with gum-
water, or with a little cinnamon-water, or with
lime-water, or with barley-water, according to
the states of the bowels.

105. ii. Treatme7it of Glandular and Follicular
Enteritis and Entero-colitis. — A. The indications
and means of cure in the acute stales of these
varieties entirely depend upon their exciting
causes, their association with muco-enteritis,
and the state of the constitutional disturbance.
The first object is to ascertain the cause or
causes of the malady ; the next is to ascertain
the state and stage of the local and general
morbid action. It is necessary not merely to
remove the causes, but also to counteract the

poisonous influence they have exerted, both lo-
cally and constitutionally. A reference to these
causes {ii 18, 83) will show the necessity of thus
extending our views in the treatment of these
varieties. It must not be overlooked, that many
of these causes are of a septic or poisonous na-
ture ; that they consist of putrid, decomposed,
and decomposing substances, vegetable or ani-
mal, or both, which act as a poisonous or con-
taminating leaven upon the digestive mucous
surface, on the intestinal glands and follicles,
and upon the blood ; and that this effect, al-
though most demonstratively produced on these
glands and follicles, does not always, at least in
its earliest stage, consist of true or of sthenic
inflammation.^ The vital condition of these fol-
licles is changed, but not in such a manner as
to develop an excited condition of their capil-
lary circulation ; an opposite state — an asthen-
ic congestion with impairment of their vital
manifestations and vital cohesion — more prob-
ably obtains ; for it is uniforndy observed, that
when the causes are of the above description,
or when they are such as debilitate, or even
such as insufficiently excite or nourish the
frame, as inappropriate, innutiitious, fluid, and
unwholesome food, a treatment of a lowering
or depleting kind is always injurious. As this
morbid condition of the glands and follicles of
the digestive villous surface often rapidly pass-
es into ulceration, it has been too generally
viewed as being altogether of an inflammatory
nature. This error has arisen from two cir-
cumstances : first, the general belief that ulcer-
ation can proceed only from antecedent inflam-
mation ; and, second, that inflammation is a
state of vascular action always attended by
one and the same condition of vital tone or
power, and that the tissues affected by it pos-
sess the same degree of vital cohesion on all
occasions. Now I have shown, in other pla-
ces, that ulceration may occur and proceed
without any appreciable grade of inflammation,
and more particularly of true or sthenic inflam-
matory action ; and that inflammations, or, rath-
er, that the states of local vascular action, to
which the term inflammation has been too gen-
erally and often inappropriately applied, are
widely different from each other, in respect of
a great variety of both local and constitutional
phenomena ; and that these states vary, as re-
gards the condition of the tissues and vessels,
and circulating fluids and vital manifestations,
not only in each of their more specific forms,
but also in each of their progressive periods or
stages. It may, therefore, be inferred that,
when ulceration is produced in the intestinal
glands by septic or contaminating ingesta, it
assumes somewhat of a phagedenic character,
and that the state of vascular action preceding
or giving rise to this eflfect is either not truly
inflammatory, or is that to which I have appli-
ed the term of asthenic infiammation (see that
article, ^ 54, ct seq.), and which requires, both
locally and constitutionally, a very different
treatment from that appropriate to the more
common inflammatory condition.

It is not improbable, however, that inflam-
mation commencing in the villous surface it-
self will extend to the follicles, and even that
both it and the follicles may be almost coeta-
neously attacked ; or that the affection of the
former may subside as that of the latter is de-

682

INTESTINES— Inflammations of— Treatment.

veloped ; but of either of these states of dis-
ease we have no certain proofs at an early
stage, although appearances after death fre-
quently show that they must have existed.
The chief difficulty is to ascertain the symp-
toms by which they are severally or con-
jointly attended and indicated, more particu-
larly during early periods of life, when this
morbid association is common ; and even at
much later periods, so minute a diagnosis as
this is can rarely be made with precision.
When we have reason, from the nature of the
exciting causes, from the character of the
symptoms, and especially from the state of the
evacuations, to infer that disease of the folli-
cles is associated with inflammation of the vil-
lous surface ; or when the more usual phenom-
ena of follicular enteritis cannot be connected
with the septic and lowering causes mentioned
above (^ 18, 85), and when the symptoms indi-
cate more or less of vascular excitement, lo-
cally or generally, local depletions, followed by
the warm bath, by the semicupium, or by the
rubefacient embrocations or fomentations al-
ready noticed (ij 296, 311), will then be requi-
site. If fajcal collections have not been re-
moved by the natural action of the bowels, calo-
mel with rhubarb, or the latter with sulphate of
potash, or the compound jalap powder may be
given, and be aided by suitable injections : af-
terward, frequent doses of the hydrarg. cum
creta, with Dover's powder, or with ipecacu-
anha and rhubarb in small quantity, may be pre-
scribed, according to the circumstances of the
case ; and the turpentine fomentations already
mentioned {^ 99) may be applied on the abdo-
men. The treatment, in such circumstances,
should not vary materially from what is ad-
vised for the more acute forms of mucous diar-
rhaa (^ 99), and for dysentery, according to the
features of individual cases.

106. After the more acute symptoms have
subsided, and in the more asthenic cases, more
restorative, astringent, and antiseptic remedies
may be employed ; and more especially those
recommended for the mucous and chrome forms
o/Diarrhcea (iJ 31, et seq.). If the stage of
the disease, the state of the evacuations, and
the constitutional symptoms indicate the ac-
cession or progress oi ulceration, the means ad-
vised in the article just referred to {() 32, et
seq.) should be resorted to. In such cases, as
well as in those which have followed the in-
gestion of septic and contaminating substan-
ces, I have found the following of more or less
service, with or without the addition of opium
to either of them, as circumstances may have
required :

No. 279. R Hydrarg. cam cretil 3j. ; Pulv. Ipecacuanha
gr. viij. ; Pulv. Rhei 3ij. ; Creasoti Ttlxij. ; Mucilag. Acaciae
q. s. M. Fiant Pilulae xviij. quarum capiat duas ter qua-
terve quotidie.

No. 280. R Pulv. Ipecacuanha gr. xvj. ; Argenti Nitratis
Pulver. gr. viij. ; Extracti Humuli 3iv. ; Extr. Papaveris
3ss. ; Olei Carui q. g. Tere bene et forma in massam aiqua-
lem quam divide in Pilulas xxxij., quarum capiat unani vel
duas ter quotidie.

No. 281. R Calcis Chloridi gr. ss. ad gr. j. ; Aquse Cin-
namomi jix. ; Mucilag. Acaciie jij. ; Tinct. Camphurae
(;omp.,Tinct. Humuli, Tinct. Cardamom. Comp. aa 3j. M.
Fiat Haustue, pro re nalil .sumendus.

No. 282. R Calcis Chloridi Pulv. gr. viij. ; tere cum Pulv.
Tragacanth. Comp. 3j. et adde Pulv. Ipecacuanha gr. viij. ;
Bals. Peruv. q. s. ut Fiaut PilulaD xviij. ; quarura capiat
duas ter quarterve in die.

107. B. The chronic stales of follicular enteri-

tis and entero-colitis, particularly when ulcera-
tion has commenced, can be ameliorated oi
cured only by strict attention to diet and regi-
men, as well as by the appropriate use of med-
icine. Of the latter, but little can be added to
what has already been stated with reference to
the treatment of chrome mucous diarrhcca (ij 31,
et seq.) and chronic dysentery {() 100, et seq.).
The various methods and diversified means
there enumerated are appropriate to the states
of the disease now under consideration ; and
the treatment recommended for chronic rnuco-
enteritis is also partially applicable to them.
In the follicular form, however, of chronic en-
tero-colitis, the means of cure, both medicinal
and dietetical, should be even more restorative
than I have advised for the other varieties of
enteritis. In many cases, both medicines and
diet should be prescribed almost experimental-
ly, the effects of both being carefully watched ;
for it is impossible to infer correctly the effects
of the several means in all, or even in the great
majority of cases. In many instances, and in
several circumstances in which they occur,
powerfully tonic and astringent remedies are
most beneficial; while in others, alterative and
absorbent medicines are most useful. A spare
and farinaceous diet is usually recommended,
and yet abstinence may be carried too far, nu-
tritious and digestible food being often requi-
red, especially when the disease is prevailing
epidemically, or when it proceeds from the
more debilitating and contaminating causes.
In addition to the means already mentioned,
both here and in the articles just referred to,
others variously combined, according to the
ever-changing features of individual cases, may
be employed, more especially sulphate of qui-
nine, or the nitrate of silver, with camphor
and the extracts of hop and of poppy ; the sul-
phates of quinine and of iron with these ex-
tracts, or with catechu, purified ox-gall, and
capsicum ; the sulphate of zinc or of copper,
or the acetate of lead, with ipecacuanha and
opium; the tincture of the muriate of iron, or
chlorine-water, with the compound tincture of
camphor or of cinnamon, and any of the va-
rious astringents, tonics, and absorbents usu-
ally employed. In this variety of the disease,
the chloride of lime, or the chlorate of potash,
or any of the mineral and vegetable astrin-
gents, tonics, and antiseptics, may be prescribed,
according to circumstances ; but those astrin-
gents which are also antiseptics should be
preferred, and be conjoined with the prepara-
tions of bark, or of cascarilla, or of tormentilla,
&c. When the follicles and glands of the large
bowels are chiefly affected, and the disorder
has become chronic, or if ulceration be expect-
ed, many of the substances just mentioned may
be employed in enemata, as the nitrate of sil-
ver, the sulphate of zinc, lime-water, chlorine-
water {Pharm. Dubl), the infusion or decoc-
tion of bark, with tlie compound tincture ol
camphor, or sirup of poppies ; the chlorate of
potash, or the chlorides similarly combined ;
and the various astringent and tonic infusions
and extracts.

108. For infants and children affected by acute
or chronic follicular enteritis and entero-colitis,
very nearly the same means as have been ad-
vised for them when suffering under muco-
entero-colitis {() 102, 103) will be found appro-

INTESTINES— Inflammations of— Treatment.

683

priate. As, however, the follicular variety of
the disease in this class of patients is more es-
pecially caused by insufficient or unwholesome
nourishment, by an unhealthy nurse, by a spoon
diet, by rearing by hand or premature weaning,
by cold and humidity, and particularly by living
in a miasmatous atmosphere, or in low, damp,
and ill-ventilated cellars and apartments, a re-
moval of these causes, and attention to suit-
able diet and regimen, become most important
parts of the treatment. The patient should be
warmly clothed in flannel, and always sleep in
the arms of a healthy nurse, or have asses'
milk warm from the animal. The diet should
be regulated in other respects as already ad-
vised (s*i 104). In this, and in similar states of
disease of the digestive canal, the jelly pre-
pared from the Ceylon moss is a most appro-
priate article of food.* In aid of these means,
change of air, particularly from crowded towns,
and low, close, or unhealthy localities, to open,
airy, dry, and temperate situations, or to the
seaside, should always be prescribed.

109. iii. Treatment of Phlegmonoid or Sero-entcri-
tis. — When the inflammation either seizes pri-
marily upon the substance of the intestines, or
extends to it, or commences in the peritoneal
coat, vascular depletion should be immediate
and copious, and other remedies promptly em-
ployed. If the patient be plethoric, young, or
robust, blood should be taken very largely from
the arm, and leeches applied afterward upon
the abdomen. A full dose of calomel and opi-
um — from fifteen to twenty grains of the for-
mer and two to three grains of the latter, with
or without a grain or two of ipecacuanha, ac-
cording to the state of the stomach — ought to
he taken immediately after the bleeding, and
the hot turpentine fomentation applied over the
whole abdomen. This last should be kept con-
stantly applied, or should be renewed until the
symptoms have abated. If the stomach be ir-
ritable, the calomel and opium taken after the
bleeding, and without the ipecacuanha, will
remove this symptom, and will, particularly
when aided by the hot turpentine fomentation,
determine the circulation to the surface, equal-
ize the distribution of blood, and promote per-
spiration ; and when the fomentation can be
no longer endured, a warm bread-and-water
poultice may replace it, and may be frequently
repeated. If these means give relief, with a
copious and general perspiration, the patient
should not be disturbed for a considerable time,
nor the stomach and bowels irritated by purga-
tives or cathartics taken by the mouth ; and as
soon as it becomes requisite to procure evac-
uations and to remove offending matters, the
oleaginous or other mild purgative enemata
may be administered.

110. If the disease be very severe, or con-
siderably advanced before this treatment is in-
stituted, a repetition of both the general and
local bleeding will often be necessary ; and the
calomel and opium, in the doses already stated,
may be given once or twice daily, either until
the secretions and evacuations become free, or
until the mouth is affected, or the symptoms
disappear. If the stomach be not irritable, and
if the bowels have been evacuated, saline med-

* lAnimal jellies, as of isinglass, calf's-foot, etc., or chick-
en and mutton brolh, given warm, will be found more gen-
erally beneficial in these chronic cases than vegetable food.]

icines may be prescribed at intervals ; and the
warm bath may be ordered, with the view of
aiding the preceding means in equalizing the
circulation and promoting perspiration. If the
biliary functions be much disordered, or if the
disease does not yield readily to the above
means, the mercurial liniment or ointment may
be placed upon the surface of the abdomen,
and covered by a succession of warm poulti-
ces, or the former of these may be laid upon
the surface of the poultices that is to be ap-
plied next to the abdomen. If this state of the
disease be associated with hepatitis, local de-
pletions below the right scapula, or over the
right liypochondrium, should precede these ap-
plications.

111. As to the use of blisters in enteritis,
much discretion is requisite. If they be em-
ployed before the disease, particularly this form
of it, be in a very great degree subdued, they
either fail of being serviceable, or they aggra-
vate the morbid action ; unless they are so
large as to occasion a complete revulsion of
the capillary action to the blistered surface :
an effect they can seldom produce, unless the
inflammatory action is slight in degree, or small
in extent, or has been nearly altogether re-
moved by the previous treatment. In the early
stages of the disease, the turpentine fomenta-
tion is greatly to be preferred, as it in no way
aggravates the disease, but, on the contrary,
remarkably tends to abate it, and to prevent
the effusion of coagulable lymph, and in this,
as well as in other ways, aids the beneficial
operation of blood-letting and mercurials.
When, however, the disease is nearly subdued,
the external inflammation and discharge pro
duced by a large blister entirely remove the
remaining morbid action, and prevent an exas-
peration or a return of it. In this period of the
disease, and after the above fomentation has
been used, a large blister may therefore be ap-
plied, and the discharge from it promoted by
poultices and other means.

112. iv. E7iteritis with membranous or tubular
exudations is generally a chronic disease, and
much less amenable to treatment than any oth-
er variety. M. Roche states that M. Burdin,
a physician of large experience in Paris, inform-
ed him that local depletions, poultices, warm
baths, emollient enemata, and a soothing regi-
men, proved most beneficial in his practice ;
and that a mucilaginous, diluent, and fluid diet
was generally injurious ; while mild, bitter in-
fusions, aromatics, and antispasmodics were
preferred ; and the former physician adds, that
his experience accords with this statement.
However, he has seen a case exasperated by
the slightest stimulus, and cured by a severe
antiphlogistic regimen ; and another cured by
drastic purgatives, after other means had failed.
Dr. Powell observed no benefit from the use
of calomel. The practice which appeared to
him most advantageous was the steady use of
a mixture of the compound infusions of gentian
and senna, with the addition of from ft x. to it
XX. of the solution of potash, so as to procure
four or five stools in the twenty-four hours.
Sir B. Brodie informed me that he has found
small doses of cubebs serviceable in this dis-
ease, aided by an occasional recourse to an
active purgative. The purgative advised by
Dr. Powell has been most beneficial in my

684

INTESTINES— Spasm op.

practice ; but I have found it requisite to apply
leeciies to the abdomen, followed by the tur-
pentine fomentation and embrocation, by hot
poultices, and emollient enemata. A frequent
use of sweet oil, both as an article of diet and
as an aperient, has also been- of service. A
light, nutritious, and solid diet has been gener-
ally requisite ; at the same time avoiding stim-
ulants and irritants. The treatment, however,
will necessarily vary, or even be entirely dif-
ferent, in different cases, as the disease has
always been variously associated or complica-
ted in the cases which I have seen, these com-
binations often requiring as much attention as
the intestinal malady.

1 13. V. During convalescence from any of the
several forms of enteritis, the regular action of
the bowels is a matter of the greatest conse-
quence, and should be promoted, when defi-
cient, by mild and cooling aperients and laxa-
tives. At the same time, the secretions gen-
erally, and particularly the biliary secretion,
should be collected or promoted whenever they
are deficient or morbid. For this purpose, an
occasional dose of blue pill or of the hydrargy-
rum cum creta, or of Pi.ummer's pill with soap,
should be taken. A warm bath, followed by
active friction of the surface with hair gloves,
or with a coarse towel, will also be of use.
The utmost attention ought to be paid to diet.
A returning appetite should be indulged with
great caution. Mild broths, in small quantity,
with toast, or with boiled rice ; the farinaceous
articles of food, as arrow-root, sago, tapioca,
&c., and the jelly of the Ceylon moss, may be
taken at first, and continued for some time be-
fore more stimulating and solid articles- are al-
lowed. The patient ought to wear flannel next
his skin, and be careful not to expose himself
to vicissitudes of temperature or to moisture.
He should always preserve his feet warm, and
observe those articles of food which agree or
disagree with his digestive organs, carefully
avoiding those which have the latter effect.
In all respects, his diet and regimen should be
regulated in the manner advised in the article
Indigestion (<J 69, et seq.).

114. X. Of Spasm, etc., of the Intestines.
— A. The muscular coats of the intestinal tube
possess a very perfect degree of muscular pow-
er, and may be contracted in a very remarka-
ble manner, even so as to propel quicksilver
along its canal contrary to the specific gravity
of this substance. The extent of spasmodic
contraction of the intestines is rarely demon-
strated to the sense of sight, even after death.
But in dissections performed a few hours after
dissolution, it has been observed so extreme
as very nearly to obliterate the canal. The
spasmodic contraction of circular fibres, and
of the muscular coats of hollow viscera, is
shown by the action of the urinary bladder, of
the intestines, and of the sphincters ; and the
extent of relaxation of these structures is dem-
onstrated by the state of these parts, both in
health and disease. The healthy contractions
of the intestinal canal push onward its con-
tents ; but this contraction is speedily followed
by relaxation. The passage of substances
more or less stimulating along the villous sur-
face excites the action of the muscular coat,
and this action ceases in one part as soon as
the stimulus passes onward to a continuous

part. Where, however, the muscular coats are
spasmodically contracted, there is, at least for
a more or less considerable time, no consequent
relaxation, as in the healthy state. It is very
diflicult to determine the extent to which spas-
modic constriction takes place, in respect ei-
ther of the amount of the obliteration of the
canal it may occasion, or of the length to which
it may affect the intestine, and the particular
bowel affected. The spasm, there is every
reason to infer — indeed, it is sometimes dem-
onstrated — may attack several parts at the
same time, more or less remote from each oth-
er, the intermediate portions being remarkably
dilated ; and it may proceed along the intesti-
nal canal, either continuously or interruptedly,
from the stomach downward, or even in an op-
posite direction, as in colic, hysteria, and ileus,
in which it may follow either of these direc-
tions. We can hardly suppose that the spasm
extends, at the same moment, to the whole
line of the canal, but merely to portions of it,
which may be thus affected for a very varying
and indefinite period. This affection may pass
with rapidity from one part to another ; and,
as respects duration and recurrence, it may be
continued, almost permanent, intermitting, re-
mitting, periodical, and slight or tremulous.
Some portions of the bowels are more subject
to spasmodic action than others, as the duode-
num, the lower portion of the ileum, and the
lower parts of the large bowels.

115. B. Intestinal spasm is generally associa-
ted with disorder of the secreting functions of
the liver and of the digestive villous surface,
and often, also, with inflammatory action in this
surface. There is always more or less of irri-
tation of this tissue, or, rather, of the nervous
fibrils supplying this and the muscular coats ;
and this irritation is attended by a more or less
remarkable alteration of the sensibility of these
nerves, which is roused often to the most acute
pitch of sensation.

116. i. Symptoms. — The symptoms of spas-
modic constriction of the intestines necessarily
vary with its seat, degree, extent, duration,
causes, and concurrent changes. In the great
majority of cases they constitute the disease
denominated colic ; and in their moip extreme
or prominent state, particularly when spasm is
associated with farther change, or consists of
a succession of retrograde actions emanating
from a part more permanently contracted or
obstructed, they constitute, or very nearly ap-
proach, the iliac jiassion, which, however, is
often dependant upon obstruction from some
other cause, and is frequently associated with
inflammation. Pain is the most general attend-
ant upon spasm, and, like it, is usually felt in
paroxysms, or is exasperated, or is recurrent,
intermittent, remittent, and more or less acute
or violent. In some cases it is slight and ir-
regular, or it assumes the above forms in a
much less acute grade, as in the spasmodic in-
testinal contractions oi hysteria. The pain char-
acteristic of spasm is often more or less allay-
ed by pressure, unless the spasm be excited
by inflammatory action, or associated with it.
When the spasm affects the small intestines,
there is commonly pain about the navel ; and
when it is attended with flatulent distention of
the parts unconstricted, there is a tympanitic
state of the abdomen, with borborygmi, and a

INTESTINES— Spasm of.

685

sensation of the passage of air from one part
to another, the pain often, also, shifting its sit-
uation. Spasm of the duodenum has been sup-
posed to be indicated by pain in the right side,
stretching to the back, and occasionally to the
right shoulder, but often changing its place upon
the expulsion of air ; by distention of the abdo-
men, slight yellovvishness of the conjunctiva or
countenance, and deficiency of bile in the evac-
uations ; and by a soft, and sometimes an ir-
regular pulse. These symptoms, however, do
not furnish sufficient evidence either of the seal
or of the nature of the affection, although they
are attendant upon it in most instances ; for
they also accompany other complaints, more
especially torpor and other functional disorders
of the biliary organs. When the pain accom-
panying them is eased by pressure, and when
none of the signs of inflammatory action are
present, then the existence of spasm is ex-
tremely probable ; but its seat is not the more
certainly indicated by this circumstance. Nor
does pain in the right side, extending from the
cajcal region to the right hypochondrium, suffi-
ciently prove the existence of spasmodic con-
striction of tlie commencement of the colon,
although it is a sufficient reason to suspect the
presence of this affection in this part. Both
S.\uvAGEs and Monro admit the difficulty of the
diagnosis as respects the seat of spasm. This,
however, is of the less importance, as the treat-
ment is the same, whatever may be its exact
seat. But it is of the utmost moment to ascer-
tain whether or not the spasm be caused by,
or associated with, inflammatory action or
structural lesion ; and this can be detected
only by a careful examination of the previous
history and present state of individual cases.
The disposition, particularly in young subjects,
of intestinal spasm, to be followed by intus-
susceptions, and by inflammation or ileus from
this circumstance, should always be kept in
recollection.

117. ii. The causes of spasm of the intestines
are also those of spasm in other parts. — a.
The nerv-ous temperament, and the delicately
or weakly constituted, owing either to original
conformation or to the operation of the usual
causes of debility during infancy, puerility, and
puberty, are most predisposed to this affection.
Dr. Gregory has very correctly and briefly sta-
ted the predisposing causes as follows : " Hab-
itus corporis nimis sentiens, et nimis mobilis,
homines spasmis opportunos reddit; hinc ma-
lum fuiminis, infantibus, debilibus, luxuriosis,
desidibus, sanguine plenis, familiare."

118. b. The exciting causes are principally
those which irritate the villous surface of the
intestines, as all acrid, poisonous, or unwhole-
some ingesta ; flatulence, acrid bile, retained
or morbid secretions and excretions, mechan-
ical irritants, calculi or concretions, foreign
bodies, worms, biliary calculi, either passing the
biliary or other ducts, or lodged in the intes-
tines, exposure to cold, &c. Intestinal spasm
is often caused by inflammation of the bowels,
or by organic lesions implicating their coats ;
by the poison of lead, and by the numerous
causes mentioned in the article on the several
forms of Colic and Ileus. It is also frequent-
ly occasioned sympathcticalhj, by the irritation
of dentition ; by irritation or inflammatory ac-
tion in the uterine organs, or in the urinary pas-

sages ; and by affections of the mind, especially
the more violent emotions. It is a frequent
attendant upon hysteria, upon calculi in the
kidneys or ureters ; and it occasionally appears
in the course of disorders of distant parts. It
is also apt to occur in the gouty diathesis, ei-
ther as misplaced gout, or in consequence of
disorder of the biliary or intestinal secretions.
119. iii. The treatment of intestinal spasm
does not differ from the treatment of colic and
ileus, and it should be conducted according to
the principles there detailed. The chief inten-
tions are, 1st. To remove the cause or causes,
whether those acting directly on the bowels, or
those exerting a sympathetic effect. 2d. To
remove the immediate attack. 3d. To combat
associated or contingent disease, whether in-
flammatory or structural ; and, 4th. To prevent
a recurrence of the affection by such means as
will prevent accumulations of morbid secretions
and excretions, and promote a healthy condi-
tion of the secretions, while they restore the
tone of the parts and of the system generally.
It is unnecessary to describe the modes in which
these indications may be carried into effect, as
they are already stated in the article just refer-
red to, and as they necessarily differ according
to the peculiarities of each case. I may, how-
ever, remark, that the use of opiates, or of oth-
er narcotics, should not be long persisted in,
with the view of accomplishing the second in-
tention, without alternating or combining them
with mild purgatives or laxatives, or with de-
obstruents ; taking care, at the same time, to
remove inflammatory action, if it be present in
any degree. Narcotics, especially opium or
morphia, interrupt the biliary and intestinal se-
cretions and excretions ; and, although the lat-
ter is extremely efficacious in removing spasm,
yet it counteracts the other indications. Much,
however, will depend upon the modes of com-
bining or prescribing it, and upon the other
means employed. Hydrocyanic acid is often a
most efficacious remedy in this affection. In
the violent forms of it which sometimes occur
in the gouty diathesis, opiates and the hydro-
cyanic acid have been most efficacious in my
practice, particularly when given with camphor
and an alkaline carbonate, or with the carbonate
of magnesia or of ammonia, due attention be-
ing paid to the excretions, both faical and uri-
nary. Belladonna is frequently of service, giv-
en either internally or applied by means of a
plaster over the abdomen. The administration
of narcotics or anodynes in encmata is occa-
sionally beneficial ; but I have seen the doses
of those medicines recommended by some wri-
ters produce very serious effects. The spirit
of turpentine thus employed is an efficacious
remedy, especially when much flatulent disten-
tion is associated with spasm, and particularly
when its antispasmodic operation is aided by
the external application of it, in the form either
of epithem, embrocation, or liniment, over the
abdomen. Numerous other means may be re-
sorted to in the different states of intestinal
spasm. But they are fully noticed in the arti-
cle on Colic and Ileus (>) 50, et seq.). The
fact of spasm being not infrequently a conse-
quence of congestion of blood, of local deter-
mination, and of inflammatory action, cither
latent or manifest, ought never to be overlook-
ed in the treatment of these affections, more

686

intestines-Palsy op.

especially in the young and plethoric, and in
those wlio live fully and take insufficient exer-
cise.*

120. XI. A P.tRALYTic STATE of the intesti-
nal canal occurs, but only in respect of portions
of it, and much more rarely than the affection
just noticed. Palsy even of a portion of the
intestines is seldom complete. It is rather a
state of over-distention, or of inflation, during
which the usual vermicular or peristaltic con-
tractions of the bowel do not take place for a
time ; but this state is more rarely permanent :
it generally disappears either gradually or after
the use of medicine or stimulating articles of
diet. In its more extreme forms, it is occa-
sionally consequent upon permanent or spas-
modic constriction, or incarceration, or stran-
gulation, or other obstruction of a portion of
bowel, and is commonly seated above the con-
striction ; the inordinate distention caused ei-
ther by flatulence, or by fajcal accumulations,
or by both, as well as by the unceasing efforts
to propel the contents of the distended intestine
onward, ultimately terminating in a loss of
contractile power. In addition to these sources
of partial palsy of the intestines, hysterical af-
fections, irritation of the uterus, and more
particularly diseases of the spinal chord or its
envelopes, causing more or less of paralysis
of voluntary parts, may be mentioned.

121. A paralytic state of a portion of the
intestines, particularly when consequent upon
permanent contraction of a part immediately
below it, is often followed by serious changes
in the palsied portion. The secretions of its
villous surface are suspended, and inflamma-
tory action, quickly passing into ulceration, or
even sphacelation, soon supervenes. Indeed,
these consecutive changes may take place even
in those parts which are not completely para-
lyzed, but which, having lost much of their
contractile power, continue more or less dis-
tended ; this condition, in connexion with the
influence of accumulated and pent-up flatus,
arresting the secretions of the part, and favour-
ing the occurrence of inflammatory action and
its usual consequences. In cases where per-
manent contraction, or obstruction of a portion
of bowel exists, from changes about to be no-
ticed (^ 127, 128), the parts immediately above
the contraction are generally found inordinately
dilated, ulcerated, ruptured, or even sphacela-
ted ; and others still higher up the bowel are
occasionally spasmodically constricted — chan-
ges resulting from the inordinate efforts made
to propel the contents of the intestines. A
partially paralyzed state of the bowels may
likewise proceed from inflammation of the part
thus affected, the muscular coats being thereby
rendered incapable of contracting.

122. i. The symptoms of palsy of the intesti-
nal canal are chiefly constipation, distention,!

* [A very successful mode of treatmeut in these cases is
that of griitlually forcing up, l)y injection, a large quantity
of some bland fluid until it reaches the seat of obstruction,
or of spasm, when a speedy evacuation and relief will gen-
erally follow. In many instances several quarts will be re-
quired before this result takes jilace ; but in all curable
cases, if seasonably applied, more speedy relief may be ex-
pected from this means than almost any other. It shoud be
succeeded, however, by some mild laxative, as olive oil, in
a large dose, and the diet for some time afterward be of a
light and fluid nature.]

t In some cases of lead colic I have found the colon so
enormously distended, from flatus and loss of contractile

with a tympanic state of a part or of the whole
of the abdomen upon percussion ; a weak,
quick, small, and often an irregular pulse, and
occasionally vomiting. The other symptoms
vary with the changes either occasioning or
associated with the palsied condition ; with the
presence of inflammation, of disease of the
spine or spinal chord ; with uterine or urinary
irritation, or with hysterical affections. When
the spinal chord is seriously affected, and in
certain severe forms of hysteria, the urinary
bladder is often also paralyzed ; and the volun-
tary muscles, particularly those of the lower
extremities, and sometimes those of the abdo-
men and superior limbs, are similarly affected.
123. ii. The treatment should be conducted
with a strict reference to the source of the af-
fection, and to the disorders attending or com-
plicating it ; and this can be accomplished only
after a strict examination of the history and
existing state of each case. If the loss of con-
tractile power proceed from a more or less
permanent contraction, or from incarceration
or strangulation of a portion of bowel, or from
pressure or some other mechanical cause of
obstruction, the removal of the source of mis-
chief is the primary object of treatment. Other
associated lesions just mentioned also require
immediate attention, as either causing or per-
petuating the palsied state. It is compara-
tively rare that this affection of the intestines
is primary and uncomplicated ; and it is conse-
quently but seldom that the means of cure
should be solely directed to it. But when it is
thus primary and simple, or dependant upon
disease or injury of the spine, warm purgatives
and carminatives, given by the mouth, and ad-
ministered in enemata, are then beneficial ;
and these may be combined with various anti-
spasmodics, more particularly those just men-
tioned (^ 119). If, however, there is any rea-
son to suppose that the loss of contractile
power is either a consequence of, or associated
with inflammation of the bowel, or even that
the distended portion of intestine has passed
into this state, then these means may be more
injurious than beneficial, and the usual reme-
dies for enteritis, according to the state of local
and general action, and of constitutional power,
should be resorted to. In such cases, a careful
examination of existing symptoms, and the pres-
ence of those already shown to attend the sever-
al forms of enteritis, will guide the practitioner,
both in the diagnosis and in the treatment.*

power, that I could distinguish its form and course, in the
different abdominal regions, by the eye when standing at a
considerable distance from the patient ; and yet the bowel
has been restored to its healthy slate by repeated injections
containing turpentine, castor oil, etc., aided by stimulating
frictions on the spine, abdomen, &c.

' Lin cases ofaparalytic state of the intestinal canal, which,
we believe, is a not uufrequent cause of obstinate constipa-
tion, galvano-magnetism, applied by placing one liutton of
the conducting wires over the spinal vertebrae and parsing
the other gradually over every part of the abdomen in suc-
cession, will be found, perhaps, the most successful of all
means to rouse the nervous energy, on which both the
healthy peristaltic action and intestinal secretions depend.
One button may occasionally be placed on the tongue, and
the other in contact with a metallic bougie, introduced into
the rectum or passed over the abdomen, as in the former
case, or placed in a tub of water, in which the feet are im-
mersed : we have been in the habit of employing all these
modes of application, and with very gratifying success. A
combination of quinine, or piperinc, with some preparation
of aloes, as the compound decoction, or pill, will aid and sus-
tain the effect of the galvanism, which, without some in-
ternal stimulant of this kind, might only be temporary.]

INTESTINES— Contraction of a Portion of.

687

124. XII. Rupture of the Intestines is
generally a consequence of pre-existing disease
of the ruptured part or its vicinity. It never
takes place in the healthy howel, unless when
caused by external violence, as the kick of a
horse, or the passage of a carriage-wheel over
t,he abdomen. — ^-1. The symptoms vary in these
cases according to the amount of haemorrhage
which takes place from the ruptured part. But
the vital powers always evince great depres-
sion from the shock and the nature of the in-
jury ; the features becoming pale and collapsed,
and the pulse feeble, small, or slow, and the
surface and extremities cold. There is also
very acute pain in the abdomen, with vomiting
or syncope, in most cases. When the rupture
proceeds from softening or ulceration, there is
seldom any hemorrhage, and the symptoms
are nearly those which arise from perforation
of the intestines ; great and general distention,
pain and tenderness of the abdomen, a small,
frequent pulse, vital depression, vomiting, con-
stipation, decubitus on the back, with the knees
drawn up, and the other symptoms of peritoni-
tis, from effusion into the peritoneal cavity, be-
ing present.

125. The treatment in the above circumstan-
ces consists chiefly of the exhibition of full
and frequent doses of opium and of perfect
quiet ; but it is more fully stated in the article
Peritoneum.

126. XIII. Thickening and permanent Con-
traction OF A Portion of Intestine. — These
lesions, whether consequent upon inflammation
or produced by constitutional vice, and impair-
ed organic nervous power, have been fully de-
scribed in the articles Digestive Canal {() 48,
ct scq.), and Colic and Ileus {() 33). In their
slighter forms and earlier stages, they are not
always, or even generally attended by such
symptoms as will enable the physician to form
a correct idea of their nature, or to infer
whether or not they are simply obstructive, or,
in addition, of a malignant character. In many
cases, where this latter character exists, the
malady is far advanced before the symptoms
marking its nature become fully manifested ;
and in some it is even neither supposed nor de-
tected until disclosed by an examination after
death.

127. i. Thickening and permanent contraction
of the coats of a portion of intestine are usu-
ally conjoined. It is but rare that the one ex-
ists without the other. They are much more
rarely observed in the small than in the large
bowels. They are usually attended, in their
early stages, by costiveness, or by constipation,
alternating with diarrhcea and colicky pains.
The symptoms, however, vary according to the
seat of a partial, or of a more or less complete
obstruction. (See Colic and Ileus, () 32, et seq.)
When they are seated in the small intestines,
vomiting frequently recurs with twisting pains,
occasionally with a gurgling noise about the
umbilicus, and the matters vomited are often
more or less digested. When they implicate
the ileo-caecal valve, or the vicinity, pain is
generally felt in the cajcal region ; and if the
obstruction be not complete, the fajcal matters
which have passed into the large bowels, to-
gether with the decretions and excretions from
their surface, generally form scanty and costive
evacuations. When the obstruction is more

complete, the sufferings of the patient are
greater, the evacuations are scantier, and the
bowel above the obstruction becomes more di-
lated and tympanitic, ultimately inflamed, and
occasionally ulcerated, or even lacerated or
gangrened. In such cases, the abdominal ten-
sion, tenderness, and pain, the frequent small
pulse, vomiting, &c., indicate the existence of
inflammatory action ; and the appearance of
the vomited matters, and the seat or commence-
ment of the suffering, suggest the portion of
intestine affected. In most cases, the abdomen
is very resonant on percussion ; but if the ob-
struction be caused by much thickening of the
coats of the intestine, there is marked dullness
of sound on percussion in the situation of the
part thus affected. The parts most liable to
thickening and constriction of the coats are
the sigmoid flexure and the arch of the colon.
When this change exists low in the colon, the
fits of vomiting are less frequent, and the evac-
uations at stool much scantier and less frequent,
than when it is seated either in the small in-
testines or at the commencement of the colon.
Even when the disease is in the sigmoid flex
ure of the bowel, as much faecal matter may
pass into the rectum, as long as the canal is at
all open, although remarkably constricted, as
will form a consistent stool, by its accumula-
tion and retention at the termination of the co-
lon and in the rectum. Thickening and per
manent contraction in the small or large intes
tines may be distinguished, with some proba-
bility, by the seat of pain and swelling, and of
the gurgling noise caused by the passage of
matters through the straightened part. If the
contraction be in the colon, its situation may
often be detected by observing how much fluid
can be thrown up, and by consulting the feel-
ings of the patient while it is being thrown
up, in addition to the other indications just no-
ticed.

128. ii. When scirrus or carcinomatous or
other malignant chronic disease attacks the intes-
tines, either primarily or consecutively (see Di-
gestive Canal, <) 48, et seq.), it is generally at-
tended not only by great thickening or hyper-
trophy of the coats, particularly of the sub- vil-
lous or cellular tissue, but also by very marked
constriction of the canal. Tumours of various
sizes, or fungous excrescences, sometimes
sprout out from the diseased or ulcerated sur-
face, which tend still farther to lessen the aper-
ture through the diseased part. The larger in-
testines, and particularly the caecum, the ileo-
caecal valve, the sigmoid flexure of the colon,
and, still more, the upper part of the recturaj
are more frequently the seat of cancerous or
malignant chronic disease than the small intes-
tines.

129. iii. The symptoms of these changes are
generally obscure, for they always come on im-
perceptibly and slowly. Distention of the bow-
els ; more frequent calls to stool than usual,
with difficulty and pain in passing the faeces ;
colicky pains, and stools consisting chiefly of
frothy mucus, often tinged with blood, are
among the earliest symptoms of the disease.
The evacuations arc only in small quantities
at a time, are thinner than natural, and, when
consistent, are much narrower, or mixed with
a frothy or slimy mucus. Emaciation takes
place, and the pulse becomes quick and feeble.

688

INTESTINES — Softening of the Villous Membrane.

As the disease proceeds, very acute lancinating
pain is felt in some part of the abdomen, com-
monly the seat of lesion. When the patient is
at stool, flatus passes through the diseased part,
sometimes with a hissing sound and tremulous
motion. As the contraction increases, the quan-
tity of fceces discharged is diminished, and ab-
dominal distention, pain, and tension are in-
creased. Occasional vomitings supervene, and
become more and more frequent, the matters
ejected being more digested, or more nearly ap-
proach the fajculent appearance, as the malady
advances to a fatal termination. In some cases
a distinct tumour may be felt, or its seat indi-
cated by a dull sound and pain on percussion.
I was lately consulted in a case of carcinoma,
seated a little above the sigmoid flexure of the
colon, which occurred in a medical man aged
about 40, where the eeat of the disease was
thus indicated. The other circumstances also,
already noticed, will farther aid in forming
an opinion as to the seat of mischief The
malady usually follows a slow but uninterrupted
course, during which the swelling of the abdo-
men, pain, vomitings, and constipation in-
crease. The countenance and general surface
in this last stage commonly present the cachec-
tic appearance usually observed in Cancer (^
11). At last, inflammation, ulceration, or even
rupture or gangrene, often takes place in the
over-distended portion of bowel above the can-
cerous part, and the patient rapidly sinks ; syn-
cope, cold sweats, singultus, feeble, intermit-
ting pulse, cold extremities, &c., ushering in
dissolution ; but the disease occasionally ter-
minates in fatal exhaustion, without these al-
terations supervening, and without the symp-
toms of ileus taking place in a very violent
form.

130. iv. Of the ^reaimfw^ of these changes but
little can be said more than will be found in
the articles Colic and Ileus (^ 71, ct seq.), and
Constipation (^ 21). I have seen temporary
benefit derived in some cases from small, but
frequent doses of Castile soap, ipecacuanha,
and hyoscyamus ; in others, from the purified
extract of aloes, conjoined with the biborate of
soda and conium. The frequent use of small
quantities of sweet oil, so as to preserve the
bowels in a freely open state, or the adoption
of the oil instead of butter, as an article of diet,
has been of service in several instances. The
injection of considerable quantities of it into the
large bowels has also proved beneficial in the
advanced states of the disease. A liniment
consisting of the mercurial and compound cam-
phor liniment, with opium, may be rubbed over
the part of the abdomen chiefly affected, or the
ammoniacal and mercurial plaster may be worn
over this part. The diet should consist of such
articles as are the least excrementitial, or fur-
nish the smallest proportion of fa;cal matters.

131. XIV. Softening of the Villous Mem-
brane OF the Intestines. — Maladic Grastro-in-
testinale avcc Disorganization GUatiniformc, Cru-
veilhier.— This lesion is fully described in the
article Digestive Canal {i, 34, et se/j.). It oc-
curs chiefly in infants and young children, and
is distinct from the softening caused by inflam-
matory action. Softening, as shown in that
article, may be primary and idiopathic, and, in
this form, is not unfrequently seated in the vil-
lous surface of the stomach and intestines, or

of either more especially. It generally pro-
ceeds from causes which greatly depress the
organic nervous power, and rarely takes place
in adult persons, in whom, however, M. Cru-
vEiLHiER, who first correctly described the dis-
ease, met with several instances. Of 50 cases
observed by Dr. Romberg, 6 occurred from the
1st to the 3d month, inclusive ; 17 from the 4th
to the 6th month ; 7 from the 7th to the 11th ;
14 from the 12th to the 24th month ; and 6 from
the 2d to the 5th year of age ; the periods of
weaning and teething being those during whith
it is most frequent.

132. i. Symptoms. — The earliest indications
of this disease are frequent, watery, greenish,
slimy or mucous stools, often mixed with yel-
lowish flakes, and having a peculiar offensive,
acid, or putrid odour ; occasional vomitings of
acid, ropy, or mucous matters, and extreme
thirst ; acute sensibility, perpetual restlessness
and fretfulness, and screaming or crying on be-
ing touched, or upon being roused from the state
of exhaustion or of lethargy into which the in-
fant generally sinks. Fever is observed at the
commencement of some cases, but it is slight,
and of short duration, and more commonly the
skin is cool from the beginning. The surface
becomes cool, or soon cold, pale, flabby, and
sickly, as the disease proceeds ; and the coun-
tenance is also pale, cold, sickly, and sunk. At
an advanced stage there are a slight or short
cough ; remarkable exhaustion or sinking ; a
short or interrupted respiration ; frequent cry-
ing and moaning ; much apparent anxiety and
restlessness ; coldness of the extremities, with
rapid emaciation and extreme debility ; an ir-
regular, languid, small, and weak pulse ; a
white, pale, or slimy tongue ; a soft, relaxed,
sometimes inflated, but never a tender or pain-
ful state of the abdomen ; and pale or whitish
urine.

133. The duration of this malady varies from
a few days to several weeks, or even to two or
three months. When the patient is carried oflT
more rapidly, disorder of a slighter form has
existed for some time previously. When the
disease proceeds unfavourably, a violent exa-
cerbation, or a gradual exhaustion or sinking
of the vital energy, usually terminates life.
The sensorial functions, in these cases, are not
oppressed by sanguineous congestion, or by
aqueous effusion, but cease in consequence of
the general vital depression and the extensive
lesion of the intestinal canal.

134. ii. Diagnosis. — If this disease have been
ushered in with fever, it closely resembles, and,
indeed, is intimately allied to, both in its symp-
toms and pathology, the Choleric Fever of in-
fants. (See that article.) The greater sever-
ity of the attack, the presence of fever, and the
more frequent vomiting and purging, are the
chief symptoms which characterize this latter
malady and distinguish it from that now under
consideration. The diarrhoea, the unoppressed
state of the cerebral functions, the extreme ir-
ritability, fretfulness, and restlessness, and the
cerebral symptoms generally, fully distinguish
this disease from inflammation of the brain or
of its membranes, and from acute hydrocephalus.

135. iii. Causes. — The predisposi7rg causes are
chiefly a weak or delicate development of the
constitution, originally deficient vital energy, a
poor or unhealthy state of the nurse's milk, and

INTESTINES — Bibliography and References.

689

the numerous other causes lowering the pow-
ers of life in early infancy. The more common
exciting causes are principally unwholesome, in-
appropriate, or insufficient food ; weaning, or
bringing up by hand, or premature weaning ;
and living in low, damp, or miasmatous locali-
ties, or in close, ill-ventilated, crowded apart-
ments or cellars, or in warm, damp, and low
districts. I have seen this disease prevalent
in low, humid, and miasmatous places, in warm
countries, and within the tropics, particularly
among the children of European parents. Many
of the diseases of the infants or children of
white parents residing in these countries are
more or less intimately related to this malady,
especially while they continue to reside in them.
M. Cruveii.hier observed it to assume an epi-
demic form in some districts of France ; and,
when thus appearing, as well as when occurring
sporadically, it is often complicated with soften-
ing of the villous coat of the stomach. When
it proceeds from the state, quantity, or kind of
food or other ingesta, it is generally thus asso-
ciated ; but, when it arises from the climate,
air, and locality, it is frequently uncomplicated.

136. iv. The structural change constituting
this malady is fully described in the article
Digestive Canal (i^ 34). Dr. Dkoste consid-
ers that the softening process may be divided
into three stages: in the first, the villous sur-
face preserves its appearance and texture, but
loses its natural consistence,- either in parts or
patches, or more or less extensively. In the
second stage, the villous membrane is converted
into a thin, soft, gelatinous, and nearly trans-
parent substance, which may be wiped off by a
sponge from the adjoining tissue, or even wash-
ed off by a stream of water poured upon it ;
yet it seems still to be continuous with, or ad-
lierent to, the subjacent coats, which are also
much softened. In the third stage, no trace of
organization is left in any of the coats, the
intestines being either perforated in various
places, to a greater or less extent, or showing
such perforations on being washed bya sponge
or stream of water. It is obvious that these
stages are merely arbitrary divisions of the
progressive advance of disorganization. As
this malady consists of a loss of the vital co-
hesion of the coats of the intestines, it will ob-
viously follow that the capillary circulation
will indicate, in these situations, some degree
of congestion, or sanguineous exudations, in
the form of ecchymoses and spots of extrava-
sated blood. Softening may take place in any
part of the alimentary canal. I have observed
it most frequently in the stomach and ileum,
and, as respects the latter, in the lower portion
of it.

137. V. The nature of this change has been
discussed by several Continental pathologists,
and chiefly by Cruveilhier, Camerer, Andral,
Droste, and Pom.mer, all of whom admit that
softening of the intestinal villous membrane
may be an idiopathic change, and independent
of inflammation. Camerer, however, supposes
that it proceeds from inflammation of the nerves
supplying the intestinal canal, terminating in
paralysis of them. From the history and phe-
nomena of several cases which I have observed,
as well as from the appearances after death, I
believe that the softening here described de-
pends upon innervation, or insufficient power,

II. 87

of the intestinal nerves, in consequence of
which condition the villous surface first, and
the other coats consecutively, lose their vital
cohesion. This view is confirmed, moreover,
by the effects of the remedies employed in
cases manifesting the usual symptoms of the
disease.

138. vi. Treatment. — The causes and circum-
stances connected with the production of the
complaint should be ascertained and removed.
The health of the nurse, and the state of her
milk, ought to receive attention. If the infant
be weaned, the diet must be duly regulated as
to quantity and quality. Thirst, which is a
general feature of the disease, should be al-
layed by frequent sippings, and never by full
draughts. Asses' milk, or milk and water, or
lime-water, may be given often, but in small
quantity ; and if any additional food be allowed,
it should be suited to the reduced state of di-
gestive and assimilative power, and to the age
of the patient. The medicines most appropri-
ate to the disease are the preparations of iron
and of lime, and the more permanent and astrin-
gent vegetable tonics. Of the former, the sul-
phate and muriate of iron are the most servicea-
ble ; and of the latter, the powdered CascariUa
bark. At the Infirmary for the Diseases of Chil-
dren, I usually gave this bark with either of these
salts in the form of powder, and very generally
with the best results, when the patient came
under the treatment in any of the earlier pe-
riods of the disease. This practice has been
adopted in this institution since my earliest
connexion with it (in 1820) ; and a similar
treatment has been found successful in Ger-
many by Drs. Pommer and Droste. In addi-
tion to these means, I have frequently pre-
scribed warm salt-water bathing, and assid-
uous frictions, with stimulating liniments along
the spine ; and I have occasionally employed
the iodide of potassium with advantage. An
improvement in the pulse and other symptoms
has often been observed on the second and
third day after this course of treatment has
been adopted. In this complaint, as in all oth-
ers depending upon vital depression, particu-
larly when occurring in large towns, and in
other unhealthy localities, change of air, par-
ticularly to the seaside, is a most important
part of treatment ; and, when aided by suitable
diet and regimen, and by appropriate medi-
cines, will generally remove the disease, if ac-
tual disorganization have not taken place.

UiBLioo. AND Refer. — Femelius, Pathol., lib. vi., cap.
ix. — Tulpius, Observ. Med., lib. iii., cap. 18. — Horslius,De-
cus Problematum de Morl)o Intest. Mesent. et Oinenli.
Gicss., 1609. — V. dc Petrone, Uuellum Literariuni inter
Medico-Saleniitanos et Neapolitanos de Phlegnione Intesti-
iiorum, 4to. Veiiet., 1647. — J. C. Ptyer, Ex. Aiiat. Medica
de Gland. Intestinorum, earurnque Usu et Atfectibus, 8vo.
Schaffh., 1677. — Amatus Lusitanus, Cent. vii.,cur. 93. — G.

E. Stahl, De Intestinis, eorumque Morbis ac Syniptoiiiatibus
cognosceiidis et curandis, 4to. Ilalle, 1684. — G. Thomasius,
Ephenier. Med. Phys. German., dec. iii., an. iii., obs. 190,
p. 319. — C. B. Behrens, Ibid., dec. iii., an. v. et vi.,obs. 34,
p. 77. — J. M. Hoffmann, Ibid., dec. iii., ann. ix. et. x., obs.
60, p. 124. — K. (,'amerarius, De Vitiis Machine Hunianie,
Diss. IV. Tub., 1726.— D. /. A. Fischer, De Morbis Intes-
tini Coli ex Anatomia dijudicandis, 4to. Erford, 1728. — A.

F. Walthcr, De Intest. Angustia ex obfirmato eorum Uabi-
tOs Vitio, 4to. I.eips., 1731. — Morgagni, De Sedibus et
Causis Morb., Epist. xxxi., 19, xxxiv. et xxxv. — Buechner,
De Spasmo Intest., 4to. Erf., 1741. — De Consensu Pedum
cum Intestinis, 4to. Halle, 1747. — De Consensu Primarum
Viarum cum Perimetro Corporis HumanI, 4to. Halle, 1764.
— C. Leurinck, De Morbis a Situ Intestin. Crassor. penden-
tibus. Gott.. 1756.—/. G. Bauer, Epist. de Malis Intest.,
in Halleri Disp. Med., t. ii;., p. 461.— C. F. KaltschmidI, ia.

690

IRRITABILITY— Source op.

Halleri Disp. Med., t. iii., No. 99.— C. G. Ludwig, in Schle-
gel, Thesaur. Semeiot., t. ii., No. 8. — J. Quann, Method.
Medendi Inflammationes, 8vo. Vien., 1774. — Stall, Rat.
Med., vol. i., p. 262 ; et vol. iv., p. 71. — Percival, Mem. of
Med. Society of Lond., vol. ii., p. 60. — W. Dougall, Edin.
Med. Comment., vol. ix. — A. S. Nevinson, Observ. on the
Use of Oude Merniiry in Obstruct, of the Bowels, and on
Castor Oil, 8vo. New., 1787. — W. Stark, Works consisting
of Chemical and Anatomical Observations, 4to. Lond., 1788.
— (r. F. Hildcbrandt, Geschichte der Unreinigkeiten im Ma-
gen und in den Gedarmen, 8vo. Brunow., 1790. — W. Hen-
ning, Beschriebung von der Entzijndung des Magens und
der Gedarme, 8vo. Copenhag., 1795. — B. Vogel, Methode
den Ileus von Eingekkemmten Durmbruchen zu Heilen.,
fcvo. Nurnb., 1797. — F. Duncan, Letter on a Particular
Affection of the Bowels in the East Indies, 8vo. Lond.,
1801. — E. Peart, Practical Information on Inflammation of
the Bowels, 8vo. Lond., 1802. — J. Sanden, in Annals of
MeJ., vol. vi., p. 293. — J. A. Gaitskell, Essay on Catarrhal
Inflamra. of the Bowels from Cold, 8vo. Lond., 1812. — F.
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— A. T. Sue, AperQu sur les Pneumatoses Inteslinales.
Paris, 1816.— A. Monro, The Morbid Anatomy of the Gullet,
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xvii., p. 111. — Fuschius, Ibid., t. ix., p. 116.— Louis, Ibid.,
^4. xiv., p. 185. — Buet, Ibid., t. xiv., p. 230. — Rostan, Ibid.,
t. xix., p. 332. — Corbin, in Ibid., t. xxiv., p. 214 ; et t. xxv.,
p. 36. — Trousseau, in Ibid., Jan. et Fev., 1826. — Brcton-
neau, in Ibid., Sept., 1829.— Le«re«, in Ibid., Oct., 1828.—
Gendron, Ibid., Juin et Jul., 1829.— Tou//?ioucAe, Ibid., Mai,
1830. — J. Abercrombie, Pathol, and Practical Researches on
Dis. of the Stomach, the Intestinal Canal, the Liver, and
other Viscera of the Abdomen, 8vo. Edinb., 1628, 3d ed.,
1837. — Camerer, Versuche ueber die Natur der Krankhaften
Magenerweichung, &c., 8vo. Stuttg., 1828. — J. Johnson,
On Morbid Sensibility of the Stomach and Bowels, &c., 8vo.
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Stomach, 4to. Lond., 1828.— A. Bompard, Trait(i des Mal-
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Sc. Med., 1827 et 1828,-7. O. Beirne, New Views on the
Process of Defiecation, and their Ajiplicat. to the Pathol.
and Treat, of Dis. of the Stomach, Bowels, &c., 8vo. Dub-
lin, 1833. — C. B. Chardon, Pathol, de I'Estomac, des Intes-
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lin Med. Joiirn., vol. vi., p. 384. — jR. J. Evanson and H.
Maunsell, A Practical Treatise on the Diseases of Children,
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Corps llumain, fol., fascic. iv., vii., xiv. Paris, 1837. — f.
Bouillaud, Clinique M6dirale, 8vo. Paris, 1837,3 tomes.—
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vol. ii., passim. .See, also, Bibliog. and Refer, to ar-
ticles Colic and Ileus, Constipation, Diarrhoea, and
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[Am. Bibhoo. and Refer.— .S. D. Gross, Elements of
Pathological Anatomy, illustrated by coloured Engravings
and 250 wood-cuts ; et Experimental and Critical Inquiry
into the Nature and Treatment of Wounds of the Intestines,
2d ed., 8vo. Plul., 1845, p.822.— IV. E. Horner, A Treatise on
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Fever, &c., 8vo. Phil., 1842. (See Bibliog. and Refer, of
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and Illustrations of Pathological Anatomy, 1st Am. ed.
Cincinnati and Lexington, 1844.]

INTUS-SUSCEPTION. — 5^ee art. Colic and
Ileus, ^ 38.

IRITIS.— See art. EYE.

IRRITABILITY. — Synon. IrritahiUtas ; vis
irrilalilitalis ; vis insita, Haller. Vis vitalis,
Gorter. Irritahilite, Fr. Die irritabiltldl,
Reizharkeit, Germ. Inherent power, Myotility,
Muscular Power, Contractility, Muscular Con-
tractility, Excitability, &.C., of various authors.
Classif. — General Pathology.

1. Defin. — A power or property of organized
bodies of being acted upon by stimuli, so as to give
rise to movements, manifested chiefly by muscular
or fibrous tissues.

2. This very important and generally diffused
property of animal bodies was first investigated
by Dr. Glisson. He applied the term " irrita-
bility''^ to all the sensible and insensible movements
of animals. Baglivi, Gorter, Winter, and
Hoffman used this term in nearly a similar
manner to Glisson, and it was thus commonly
employed until Haller restricted it to the sus-
ceptibility of movement in muscular tissues, and
carefully investigated its laws in those parts.
In this latter sense it was employed by physiol-
ogists, until Girtanner rejected the restricted
sense of Haller, and used it in the compre-
hensive sense adopted by Glisson.

3. i. Of the Source of Irritability. — The source
of this propert)'^ soon became a subject of dis-
cussion. Most physicians recognised it as a
manifestation of life in organized bodies ; but
the circumstance of its being called into activ-
ity by nervous influence readily suggested the
question as to its dependance upon, or inde-
pendence of this influence. Haller and his
disciples, with Fontana, Metzger, Bichat, and
others, considered irritability to be, sui generis.
inherent in the muscular fibre, altogether in-
dependent of nervous influence, and only sub-
jected, in muscles governed by the will, to the
action of the nerves, which, in this case, serve
as conductors of the stimulus intended to excite
contraction. They founded their opinion on
the facts, that muscular power is altogether dif-
ferent from the power of living nerves in its
manifestations, the former consisting of visible
oscillations and movements not perceivable in
nerves ; and that destruction of the brain and
spinal chord, or division of the voluntary nerves
supplying the muscles, does not annihilate the
power of muscular movement, when subjected
to irritation. On the other hand, Whytt,
Monro, Unzer, Prochaska, Legallois, &c.,
regarded the nervous power as the principle
upon which all muscular contractions depend,
and, consequently, irritability to be communica-
ted to the muscles by the nerves, because
nerves enter into the composition of all mus-
cles ; because the latter contract quite as well
when the former are irritated as when the
stimulus is applied to the muscles themselves ;
because irritability is extinguished by substan-
ces subversive of nervous power ; and because
the destruction of the brain and spinal chord,
and section or ligature of the nerves, cause the

IRRITABILITY— Source and Dependance op.

691

disappearance of the power of contraction on
applying irritants to tiie muscles. It is obvious,
as TiEDEMANN has remarked, that both parties
have pushed their arguments too far, and, in-
deed, have over-stated or exaggerated the facts
from which they argue. Hallkr and his dis-
ciples were wrong, and went counter to every
idea of an organized body, in which all the
manifestations of life are mutually connected,
in attributing to the muscles a faculty altogether
independent of the influence of the nervous
system. But his opponents were equally wrong
in attaching too great an importance to the
part which the cerebro-spinal nervous system
performs in the phenomena of muscular con-
tractility.

4. In the year 1820, and subsequently (see
Land. Med. Repository, for May, 1822, and my
Notes and Appendix to Richcrand's Elements of
Physiology, &c., edit. 1824, 2d ed. 1829, p. 690),
I showed, as the result of my researches into
this subject, that irritability is not dependant
npon the cerebro-spinal nervous system, al-
though it is excited by this system ; but that it
proceeds from the organic or ganglial system
of nerves* — that this latter system bestows on

* As respects the more perfect manifestations of this prop-
erty, l>y means of muscular structures, I there stated, "that,
as irritability is present in parts which do not receive vol-
untary nerves, this faculty cannot be attributed to them.
To wliat other species of organization can we refer it ? We
observe it, in the more perfect animals, displayed chiefly by
muscular parts. Is it from this circumstance an attriliute
only of muscular parts, and the pure result of their confor-
mation? One class of physiologists answers this question
in the affirmative. But irritability is manifested in the low-
est orders of the animal creation, as well as in some of the
higher, by parts in which a muscular structure cannot be
detected ; therefore, although a property of the muscular
structure, it is neither altogether restricted to it, nor is it
strictly the result of the organization of this structure, it-
dependenlly of some other. Consequently, this properly
must be referred to a conformation still more general than
the muscular tissue, as respects both the entire scale of an-
imal creation and the organization of individual species ; al-
lowing, at the same time, that a particular structure is re-
quisite to the full and perfect manifestation of this property,
but that this structure depends upon a different source than
itself for the property which it displays.

" Having arrived at the conclusion that irritability, al-
though a property of muscular parts, is not the result of
muscular organization merely, but is derived from a differ-
ent and more general system, supplying the muscular struc-
ture as well as other structures, we must next inquire what
this system is. It has l>een already shown that the organic
or ganglial nervous system is distributed in various propor-
tions to all the textures and organs of the body ; that this
system is similarly distributed throughout all the individu-
als composing the animal kingdom ; that in some animals it
is the chief nervous system ; that not only is it present
wherever irritability is manifested, but it is the most gen-
erally diffused of all the tissues ; that no other structure
than this exists which can be shown to be present in every
species of irritable or contractile parts, in all orders of ani-
mals ; and, consequently, that to no other source than this
can irritability be assigned.

" Having inferred that the muscular fibre is only the in-
strument of contraction in its more perfect condition — that
it performs the functiim in consequence of a certain confor-
mation, and owing to that conformation being endowed by
another still more generally diffused than itself^and that
this property is derived from the ganglial, or soft nervous
system — we are led farther to infer that the cerebro-spinal
nerves are distributed to muscular parts for specific purposes,
but that these parts do not derive their innate properties
from these latter nerves — these nerves merely exciting
them, or acting as conductors of a stim'ilus to properties
which proceed from a different source. I have contended
that these properties are not innate, or the consequence of
the conformation of the muscular fibre itself; but are de-
rived from a conformation more general, surrounding or
otherwise connected with the muscular fibrils, and that
this more general conformation is the organic nervous sys-
tem. Conceiving, therefore, that this system, in its state
of ultimate distribution and dissemination in the texture of
a muscle, whether in the form of unarranged corpuscles or

muscular or fibrous tissues the power of con-
traction, while the spinal nerves simply con-
duct or convey the stimuli to contraction.
This statement, with the proofs and arguments
in its favour, appeared at the time just stated;
and in 1835 — fifteen years subsequently — Dr.
Fletcher published lectures {inLond, Med. and
Surg. Journ., vol. vii., p. 327, ct seq.), in which
not only the same statement, but also the iden-
tical proofs and arguments which had been
urged by me in the works above referred to,
were adduced by him as his own original
views, and in some parts in nearly the same
words as I had there employed. In the repub-
lication, however, of these lectures, and in a
different form, some reference was made to
the originator of these views, but in such a
manner as showed that the act was one of
compulsion rather than of inclination.

5. As expressed in my published notes on
this subject, and on others connected with it, I
have suggested that the different departments
of the nervous system have been hitherto
viewed in a much too restricted manner ; and
that, instead of considering the different orders
of nerves as ramifications shooting forth from
the large nervous masses, it would be equally,
if not more correct, and consistent with the
gradual rise in the scale of animal creation,
and with the development of the tissues and
organs in the higher animals, to view them as
originating in the different structures and or-
gans in which they have hitherto been said to
terminate.* The reasons which I assigned

of minute and variously arranged fibrils resulting from the
regular distribution of these corpuscles, is the chief source
of the property evinced by muscular parts of every denomi-
nation, I farther conclude that the cerebro-spinal nerves do
not produce their specific effects on muscular fibres, owing
to a nervous fibril being ramified to each muscular fibril,
for this does not take place ; nor do these effects proceed
from the direct influence of these nerves upon the muscular
fibril, for the muscular fibre has been shown to derive its
property or faculty of contraction from a source different
from itself and from the voluntary nerves which occasion-
ally excite its contractions ; but tfiat these nerves seem to
act directly upon the ultimate distribution or corpuscles of
the organic nervous system in the muscle, which system
bestows on it the faculty of, or disposition to, active con-
traction, on the application of a stimulus ; and this faculty
ail muscular parts possess, although some of these parts
only are supplied with voluntary nerves, and are liable to
be acted upon by cerebro-spinal influence. The mode of
termination of voluntary nerves in muscular parts also fa-
vours the opinion now stated. These nerves terminate, as
already noticed, in such a manner as leads me to infer that
they become, in the textures which they supply, gradually
identified, as it were, or amalgamated, with the ultimate
distributions of the ganglial nerves ; and the history of the
embryo and the progressive development of the nervous sys-
tem in the lower animals lead me to believe that the volun-
tary nerves originate in the textures which they supply;
that they proceed from the ganglial system ; and that their
larger branches, the spinal marrow, and encephalon are
successively formed."

* •' Viewing the nervous system throughout the numer-
ous classes of animals, and tracing the process of its forma-
tion from the embryo up to the period of perfect foetal ex-
istence in the higher animals, I am led to infer that this
system is not originally formed from the centre towards the
circumference, but that the origin of its ramifications com-
mences in the mucous or cellular tissues, when the embryo
IS yet but in an apparently homogeneous state ; and that as
the textures become, in the process of ftetal growth, more
and more developed, so the corpuscles composing the rudi-
mental nervous system, and chiefly those of the ganglial
system of nerve.s, are arranged into chords of communica-
tion, chiefly in the course of the vessels, for the purpose of
preserving a connexion between the organs, and re-enforcing
each of the textures with the influence which those systems
generate in their perfect states of development. As the
embryo is formed, the nervous ramifications advance to-
wards centres, which vary in their characters according to
the genus of the animal : in those which are more perfect

692

IRRITABILITY — Sourck and Dependance op.

for this mode of investigation, and for adopt-
ing it in addition to the one-sided mode of
viewing this subject hitherto pursued, need not
be here repeated. I may, however, briefly
state, that the lowest grades of animal bodies,
and the earliest stage of animal formation, dis-
play merely minute granulated or nucleated
globules or corpuscles, more or less abundant-
ly disseminated throughout the cellular and
other tissues ; and that, as these tissues are
more visibly developed, and assume a more
truly cellular and fibrous conformation, from
the almost albummous state of the earlier stage
of their formation, so the gray fibres constitu-
ting the organic nervous ramifications become
visible in connexion with these corpuscles. In
the fully-developed state of animal organization
these granulated corpuscles are numerous and
demonstrable in the tissues, particularly in the
ganglions in connexion with the gray organic
fibres, and in the muscular fibrils, both invol-
untary and voluntary. But, whether these
corpuscles are formed before the large nervous
masses connected with sensation, volition, &c.,
or contemporaneously with these masses, is of
little consequence. The most important ques-
tion is, what is the function performed by these
corpuscles 1 When we recollect that these
bodies are found disseminated through the al-
buminous and otherwise almost inorganized
structure of polypi, and throughout the tissues
of others of the lowest animals, which manifest
irritability as their most important function,
and when we know that these animals are
capable of being multiplied by division, and
that parts cut oflf from them have separate
existences, it seems highly probable that the
vital functions they display — that irritability
proceeds from this peculiar organization. Hav-
ing farther observed these granulated corpus-
cles disseminated through other tissues, in an
abundance proportionate to the amount or grade
of vital function — having detected these corpus-
cles in great numbers within the delicate mem-
brane investing the primitive fasciculi of volun-
tary muscular fibrils, and in the flattened fib-
rils of involuntary muscular parts — having
seen still greater numbers of them comprised
in the structure of the organic nervous fibres,
and constituting the chief part of the ganglia ;
and having, moreover, found them giving origin
to the gray and solid filaments of organic
nerves, as well as comprised in or embraced by
these filaments, it may be inferred that they
are mainly concerned in the production of the
various grades of irritability or contractility
manifested by the tissues in which they* are
thus dissem.inated, and to which they are thus
supplied.

6. The views which I published in 1820,
1824, and 1829, respecting the constitution,

those centres are numerous, and almost each differs more
or less sensibly from the other, both as to appearance and
function." — See Author's Notes, &c., to M. Richerand's
Elements of Physiology, &c., p. 1.

* Schwann and more recent microscopic observers and
physiological writers, both foreign and British, suppose that
these granulated corpuscles are merely the nuclei of the
cells from which, according to him, all the tissues are de-
veloped. That this, however, is not the case, and that these
corpuscles are intimately connected with the performance
of important functions, are shown by their higher and more
complex organization, and by the circumstances of their
constituting the principal part of the composition of the
ganglia and of the organic nerves. I would therefore de-
Dominate them the organic corpuscles.

connexions, and functions of the organic or
ganglial neivous system, have been more re-
cently (from 1831 till 1840) confirmed by the
researches of Retzius, Giltay, Muller, and
Valentin. The organic, or gray nerves, do
not consist, as the motor and sensitive nerves
of the spino-cerebral axis do, of parallel tubes
containing a liquid matter, but are altogether
homogeneous, pale, almost transparent, and
peculiar in their form, distribution, and con-
nexions. They are intimately connected with
the granulated or nucleated corpuscles dissem-
inated throughout the tissues, and they either
enclose, or are otherwise associated with,
these corpuscles or globules in great numbers,
both in the ganglia and in the plexuses and
ramifications. The gray, or ganglial nerves,
thus seem to arise from the organic globules
just described, especially from those contained
in the ganglia. The ganglia should therefore
be regarded as the central organs of the organ-
ic nervous system ; and the white fibres which
run to and through them, especially in the lat-
eral chords of sympathetic ganglia, without
having any intimate connexion with the gran-
ulated corpuscles of the ganglia, and merely
passing between these corpuscles, are the sen-
sitive and motor fibres of the nerves derived
from the cerebrum and spinal chord. The or-
ganic, or gray portions of the nervous system,
and more especially of those parts of it lodged
in the abdominal, thoracic, and cervical re-
gions, preside over the organic and truly vital
functions ; and their connexions with the cere-
bro-spinal centres are such as evidently show
that they are ramified thither in order to en-
dow these centres with the organic nervous
power in common with other parts of the econ-
omy ; nerves proceeding from these centres
also being ramified to the ganglia to supply
them with the sensitive and motor influences.
The nervous connexions or ramifications be-
tween the ganglia and cerebro-spinal axis thus
consist of the solid or homogeneous gray fibres
of organic nerves conveying the strictly vital
or vegetative influence to the brain and spinal
chord, and of the whitish tubular fibres of mo-
tor and sensitive nerves transmitting the influ-
ence of these organs in various degrees to the
viscera engaged in the strictly vital operations.
In those parts which perform complex functions,
as the organs constituting the face, mouth,
throat, &c., and the organs.of generation, which
are endowed with the functions of secretion,
sensation, and motion, the nerves proceeding
thither consist both of the gray fibres of organ-
ic life, and the white tubular fibres of sensitive
and motor nerves.

7. From what has been here stated, from
the most recent researches, and from the con-
formation detected by microscopic observation,
the results of my own investigations many
years since, as published in the works already
referred to, have been fully confirmed, namely,
that the organic or ganglial nervous system
presides over the strictly vital functions, and
that all the grades and manifestations of irrita-
bility or contractility proceed from this source.
It is extremely probable that the organic or
nucleated corpuscles disseminated throughout
the structures, and particularly in fibrous and
contractile parts, bestow a certain share or
grade of contractility upon them, and that an

IRRITABILITY— Grades op.

693

additional or even a principal share of this
properly is contributed by the ganglia and or-
ganic nerves distributed to them. Indeed, this
is shown by numerous observations made by
me in 1812 and 1813, when it was proved that
the hearts of fishes continued to contract for a
considerable time after they were removed
from the animals, and from all the nervous
structures external to themselves ; while influ-
ence of the ganglia on the involuntary muscles
was proved by the application of powerful stim-
uli to the cceliac ganglion having caused in-
creased peristaltic movements of the intestines
that continued for some time. (See a notice of
these experiments in my " Notes," &c., already
referred to.)

8. In the organic muscles, which possess ei-
ther a power of almost continued action, or a
certain rhythm of action, as the heart and ali-
mentary canal, the organic nerves are plenti-
fully distributed, and abound with the organic
corpuscles above described ; showing that the
unexhausted irritability of these parts is chief-
ly owing to this organization. The facts and
arguments adduced so many years since by me,
in proof of the dependance of irritability upon
the organic nervous system, have been very
recently urged, with little variation, by Doctor
Fletcher, and by several German Avriters ;
but what they have advanced merely confirms
what I had published, fully explained, and made
even the basis of a system of general and spe-
cial pathology, many years previously, in the
works above stated. Among others, the sub-
joined remarks* of Mueller, from the able
translation of his Elements of Physiology, by
Dr. B.tLY, may be adduced in illustration of
what I had stated long since respecting the
functions of the organic or ganglial nervous
system, and the source of irritability. After
stating the same facts as have been advanced
by me, he draws the same inference, namely,
"that the organic nerves distributed in the
muscular substance have a principal share in
the production of their automatic movements,
and that the rhythmic contractions of the or-
ganic muscles are not independent of the
nerves, as Haller believed." (P. 913.) The
error of those who contended that irritability
was independent of nervous influence arose
from the circumstance of their confounding the

* " It has been proved that the automatic movements of
the orgtinic muscles, like all muscular motion, depend pri-
marily on the influence of the nervous principle ; that the
cause of the rhythm of these automatic motions is not con-
nected with the nature of the mirscular fibres, but with the
peculiarity of the nervous system of the organic muscles ;
and that the ccpliac ganglicjn has the property of exciting,
when irritated, *he peristaltic motions of the intestines. It
appears, moreover, that the sympathetic nerve retains its
ganglionic structure even in its more minute ramifications ;
and the power of the intestine to perform its peristaltic mo-
tions is found to be preserved even when it is separated from
the mesentery. From these facts, then, I conclude that
even the minute branches of the sympathetic, which ramify
in the intestinal coats, have the same power of causing pe-
riodic contractions as the cteliac ganglion was proved to
possess. The explanation which applies to the peristaltic
movements of the intestines has the same force with rela-
tion to the rhythmic motion of the heart, the first observed
motion of which, in its simple tubular condition, is indeed
of a peristaltic nature. Since, therefore, not merely the
larger gangUouB of the sympathetic, but even its ultimate
ramifications in the tissues of organs, seem to possess the
power of giving rise to periodic motions, we can understand
liow the rhythmic movements of the heart, intestine, and
oviduct of the turtle are enabled to continue when these
organs are removed from their connexions in the body." —
Mueller's Fhysiology, Baly, p. 914.

cerebro-spinal nervous influence, or sensitive
and motive function, with organic nervous pow-
er, or the strictly vital manifestations. Hal-
ler, believing that there was only one species
of nervous influence, and that it proceeded from
the brain, considered the irritability of muscu-
lar parts to be what it really is, independent of
this part of the nervous system ; but his argu-
ments and facts left entirely unaffected, or,
rather, confirmed the view, first advanced and
supported by me, that this property of animal
bodies proceeds from the organic nervous sys-
tem, which system I showed to be altogether
distinct from the cerebro-spinal nervous sys-
tem, its functions being different from those of
the other system, and altogether of a strictly
vital character.*

9. From what has been now stated, it will
be inferred that irritability, according to the
sense in which it has been viewed by Haller
and others, is the contractility, or power of con-
traction, possessed by muscular parts, and dis-
played by them when acted upon by stimuli or
irritants. In the wider sense of the word, ac-
cording to Glisson and others, it is the power
of sensible and insensible contraction possessed
by most living tissues. The molecules of mat-
ter, composing the living structures, are pre-
served in a state of cohesion, varying in grade
in the different tissues. This variation in grade
depends upon the organization of the tissue,
and upon the state of its vital endowment.
That the organization affects the cohesion of a
particular structure, does not require proof;
and that the state of vitality exerts a marked
influence upon the cohesion of the tissues gen-
erally, is shown by the gradual loss of cohe-
sion, as vitality departs, and as it becomes re-
duced in the progress of diseases characterized
by exhaustion. The state of the blood also af-
fects the cohesion of the structures, but most
probably by first reducing vital power. From
this intimate dependance of structural cohe-
sion upon vitality, the term vital cohesion of the
tissues may be used with reference to some
of the most important conditions presented by
them in health and in disease. As the pow-
ers of life are perfect and strongly manifested,
so cohesion is perfect ; and, as these powers
are reduced, so it also is reduced. Hence it
becomes an index, in many diseases, of the
degree to which this reduction has taken place,
the firmness and tenacity of the tissues, and
the duration of these properties for a time
after death, varying with the reduction of vital
energy.

10. ii. 0/ the Grades of Irritahility. — The vi-
tal cohesion of the tissues is one of the earliest,
the most generally diffused, the lowest, and the
most persistent of vital phenomena. It fur-
nishes, as it were, the basis for all the other
manifestations of life ; and as it becomes weak-
ened, or ceases, these manifestations more or
less completely disappear. As long as the tis-
sues are endowed with life, vital cohesion
continues, varying, however, in grade with the
circumstances just stated. Of the parts pos-
sessed of vital cohesion, a very large proporl ion

* On this subject the reader is referred to the London
Medical Repository, vol. xvii., p. 370, et seg. ; and to the
Author's Notes and Appendix to M. Richerand'.s Elements
of Physiology, where will be found the s.-ime facts and opin-
ions stated as early as 1820, 1S22, and 1824, as have been
e*poased by Mueller, and others much more recently.

694

IRRITABILITY — Conditions necessary to.

present certain gracies and modes of contractili-
ty which have been variously denominated.
Contractility is essentially a vital phenomenon,
and results from changes in the vital endow-
ment of a structure affecting the relative posi-
tion of the molecules composing such structure.
Vital contractility may be divided into grades,
commencing with the lowest and the most gen-
erally diffused grade of this property of living
parts — with that grade the next above simple
vital cohesion, in the scale of animal mani-
festations.

11. 1st. Insensible crrganic contractility, or that
state usually denominated tone or tonicity, is,
like vital cohesion, not confined to the animal
kingdom ; it is a property of vegetables and of
animals not possessed of a heart. It is dif-
fused throughout the tissues, and may be
viewed as merely a higher grade of vital co-
hesion, or, rather, this latter may be considered
as the lowest manifestation of life in organic
structures, insensible organic contractility or
tone being the next in the scale. This prop-
erty, equally with the preceding, results from
the vital influence with which the structures
are endowed — is perfect, as this influence is
perfect, is impaired as it is weakened, and al-
together disappears soon after life has depart-
ed. Insensible contractility or tone is manifest-
ed by the vascular system more especially, and
by the soft solids generally ; and it is more or
less exerted in all the vital operations — in the
circulation, in secretion, in nutrition, and in ab-
sorption, the perfection of these functions de-
pending upon its due manifestation. The or-
ganic nervous system seems to be instrumental
in its production and preservation in the animal
kingdom, as I have contended in the works al-
ready referred to.

12. 2dly. Sensible organic contractility, or irri-
tability, is that property of contraction which
exists in fibrous and muscular parts. It is ex-
cited by the application of an irritant or stimu-
lant, and depends, as I have shown above {^ 4,
et seq.), upon the ultimate organization and dis-
tribution of the organic or ganglial nervous sub-
stance or corpuscles to these parts.

13. Both these species of organic contractil-
ity result from one species of influence with
which animal bodies are endowed — they are the
proximate results of vitality, and differ from
each other, owing to the intimate structure of
the parts in which they are seated, and to the
extent to which each of the parts manifesting
these properties is supplied with the organic
nervous globules and ganglial ramifications.

14. 3dly. Cerebro-spinal contractility is the
contraction of those muscles which is occasion-
ed by volition, and by stimulants acting upon
their motive and sensitive nerves. It takes
place only in such muscles as receive nerves
from the spinal chord, medulla oblongata, and
encephalon ; and results from this conforma-
tion and connexion with these centres of voli-
tion and sensation. Although produced and
directed by volition, it may also be excited by
irritations acting upon, or conveyed to, the cer-
ebro-spinal axis, or the nerves proceeding from
any part of this axis.

15. The Jirst and second species of contractil-
ity proceed from the organic nervous system
and influence ; the third from the super-addi-
tion of the nerves of voluntary motion and of

sensation. This last form of contractility, how-
ever, may take place in voluntary muscles, in-
dependently of volition, by a " reflex sympathy,"
as shown by me in the places already referred
to ;* and independently, also, of sensation, as
subsequently contended for by Dr. M. Hall, by
means of what he has denominated a '^^ reflex
function,''' with which he supposes the spinal
chord to be endowed.

16. As the various grades of contractility are
dependant upon vital energy, and as the higher
grades of it are influenced, moreover, by the
states of the nervous systems — sensible organic
contractility, by the organic nervous system ;
and cerebro-spinal contractility by the cerebro-
spinal system— so it must necessarily follow
that they will vary in their grades and condi-
tions with the vital manifestations generally,
and with those more particularly evinced by
these systems. Hence irritability may be im-
paired or exalted, either throughout the frame,
or in one or more tissues or parts. Irritable
structures, moreover, are not only liable to al-
terations in the grades of action, but they also
evince a greater or less disposition to be acted
upon by the ordinary stimuli. The susceptibil-
ity of irritation as well as the degrees to which
the consequent contraction takes place in living
structures, vary in different constitutions and
temperaments, and in different diseases, and
even in the same disease, owing to various cir-
cumstances connected with diathesis and habit
of body, and with the nature of the exciting
causes.

17. iii. Conditions rcq^iisite to the healthy man-
ifestation of the several grades of irritability. —
From what has been stated, it is obvious that
these manifestations will be perfect according
as the vital endowment is perfect. That form
of contractility with which the involuntary
muscles are endowed, being altogether depend-
ant upon the ganglial nervous system, will ne-
cessarily be influenced by the conditions of this
system ; and that which is displayed by volun-
tary muscles will vary, according to the states
of the cerebro-spinal axis and nerves, chiefly
in respect of the degree in which these mus-
cles will still continue subjected to the influ-
ence of volition ; injury or destruction of these
parts of the nervous system leaving the volun-
tary muscles still possessed of their contractil-
ity, although in a more or less impaired form»
owing to the loss of an accustomed stimulus to
contraction ; and, as I have stated many years
ago in my physiological notes, it is reasonable
to suppose " that the voluntary nerves convey
to the organic or vital nerves a natural stimu-
lus or influence ; and that, if the latter nerves
were deprived of this additional influence, the
parts supplied with them would necessarily suf-
fer an impairment of function."

18. A. A strong proof of the influence of the
nervous systems upon irritability is furnished by

* See, also, several articles in the first volame of this
work, which were published twelve months before the ap-
pearance of Dr. M. Hall's views. In these articles (p. 322,
t) 23, p. 331, () 16, p. 424, (, 46, and p. 576, t) SI) 1 have ac-
counted for the occurrence of involuntary niovemeuts, con-
tractions, and spasms in voluntary muscles, in several dis-
eases, by showing that they proceed fiom irrilatieu propa-
gated to the roots of the spinal nerves, or to the spinal chord
itself, and thence reflected, by means of the spinal nerves,
upon the voluntary muscles. (See articles CHOLERA, Cho-
rea, <fec.. Convulsions, Disease, Epilepsy, and Irri-
tation, at the sections just referred toj

IRRITABILITY — Conditions necessary to.

885

the operation of these agents, which either ex-
haust or directly depress tiie nervous power.
Galvanism, electricity, mechanical irritation,
&c., exhaust this property, and narcotics de-
stroy it, or, at least, greatly impair it. These
effects are produced upon both voluntary and
involuntary muscles, and whether the agents
be applied to the muscular tissue directly, or to
the nerves distributed to them. In the former
case they affect chiefly the organic corpuscles
or vital nerves actuating the muscular struc-
ture ; in the latter, they produce a nearly sim-
ilar effect through the medium of the voluntary
nerves terminating in it. Many of the exciting
causes of disease, and the majority of our me-
dicinal agents, produce these effects in a sim-
ilar manner ; the several manifestations of con-
tractility being thereby impaired, exalted, or
exhausted, or specifically modified, according
to the natures or properties of such causes and
agents. From what has been stated, as well
as from obvious phenomena coming under the
cognizance of every observer, it may be infer-
red that the several grades of irritability of this
property, viewed in the sense entertained by
Glisson, are the most general and important
of the several endowments of life, and the most
requisite to the continuance of life. I have
also stated, and more fully attempted to show
many years since, that this property results
from a peculiar organization — from the distri-
bution of the organic or vital nervous fibrils
and corpuscles to the tissues displaying this
property ; and that the apparent dependance
of it, in voluntary muscles, upon the cerebro-
spinal nervous system is owing to the termi-
nation of motor nerves in these muscles, in
order to bring them under theinfluence of vo-
lition ; the high grade of irritability which they
possess being, however, derived from the or-
ganic or vital nervous system ; and probably,
also, re-enforced by the influence proceeding
from the spinal chord.*

19. It follows from the foregoing, that while
the several manifestations of irritability are all
directly dependant upon the organic or vital
nervous system — are expressions of life through
the medium of this system — one form only of
this property, namely, voluntary motion, is un-
equivocally influenced by the cerebro-spinal
nervous system ; this form, however, being
chiefly derived from the former source, although
excited and directed by the latter. Moreover,
it may be inferred that these manifestations
being dependant upon this source, the several
changes to which tliey are subject chiefly pro-
ceed from changes in the condition of the or-
ganic or vital nervous energy ; and that altera-
tions of that form of this property, which is more
intimately connected with volition, equally with
other forms, also proceed from the same source ;
a healthy state of the cerebrospinal nervous
system, and of its ramifications, being requisite

* " It appears, from the effect.s of agents upon voluntary
or other muscular parts, when directly applied to the gau-
glial or vital nerves — from the intimate organization of con-
tractile parts — from the distribution of these nerves to the
vascular system, to the extreme capillaries, and to volunta-
ry as well as to involuntary muscles— that the ganglial or
vital nervous system gives rise, in both these kinds of mus-
cles, to the piienomenon called irritability ; the different
manifestations of this property, as it is displayed in volun-
tary and involuntary muscles, resulting from the accessary
supply of the spinal nerves which the former muscles re-
ceive.— (iVo^M, ifcc, 1824.)

to the due excitement, direction, and determi-
nation of this particular manifestation of irrita-
bility. These influences, indeed, are daily il-
lustrated by the phenomena of disease, more
particularly of those diseases which implicate
tlie vital endowments manifested through the
medium of the ganglial or vital nervous sys-
tem, or which affect the integrity of the cerebro-
spinal system. In the former class of these
diseases, the irritability of vital organs is af-
fected co-ordinately with the disorder experi-
enced by the ganglial system ; and that of vol-
untary organs is also either imperfectly mani-
fested, or incapable of being determined or di-
rected. In the latter class, on the other hand,
the organic nervous system is entirely unaffect-
ed, its functions being quite healthy, and irrita-
bility also perfect throughout the frame ; yet,
owing to lesion in some part of the cerebro-
spinal system, the contractions of voluntary
muscles are either not excited, or not directed,
or uncontrolled, although the power derived
from the ganglial system still continues to be
possessed by them.

20. B. The influence of the blood upon the irri-
tability of parts is demonstrable. Stenson, Ar-
NEMANN, BicHAT, E.MMERT, Segalas, aud others,
have proved this influence, and shown that the
presence of blood in irritable textures is neces-
sary to the continuance, even for a short time,
of the property of contraction ; and that the
power of volition over voluntary muscles is
lost when blood is no longer sent to them. It
is also fully proved that arterial blood is requi-
site to the due performance of the several
grades of contractility, and that, while the con-
tinued action of this blood on irritable parts is
necessary to their functions, this blood loses
something by this action, or undergoes changes
in the course of it, that give this fluid the ve-
nous character. That venous blood is incapable
of supporting irritability in its healthy and more
persistent states, is shown by the blue disease,
and by the several modes of producing asphyxia.
The state of the blood in respect, also, of the
presence in it of either stimulating, depressing,
narcotic, or specifically alterative materials, has
also a most important effect upon the several
forms of irritability. Many of the causes of dis-
ease, many remedies, and many poisons, act
upon the frame by passing into the circulation,
and affecting, by their presence in the blood, the
different grades of this property, their influence
being exerted in this way, either upon the organic
and cerebro-spinal nervous systems, and through
them upon the irritable structures, or upon
these structures directly, or even upon these
systems and structures conjointly and coetane-
ously. The changes, also, which take place in
the blood, in the course of diseases, particular-
ly contaminating maladies and fevers, owing
either to the absorption of morbid matters into
the circulation, or to interrupted elimination of
effcete and injurious materials from it, affect the
several forms of irritability,, and even the vital
cohesion of the tissues, in the manner now ex-
plained ; the absorption or accumulaticm, how-
ever, of these excrementitious matters gener-
ally having a similar effect to that pnwluced on
the frame by animal poisons. Contractility is
affected by the various stimuli or irrit-ants
which may act either directly on irritable or
contractile parts, or on nerves supplying them.

696

IRRITATION— Preliminary Remarics.

or on the central nervous organs ; but remarks
on this part of the subject, as well as on the
varying susceptibility of irritation in different
persons and diseases, will find a more appro-
priate place in the article Irritation.

BiBLlOG. AND Refer. — Glisson, De Ventriculo et Intes-
tinis, 1678, p. 239.— Baglivi, De Fibra Motrice, <kc., Opera,
an. 1703, p. 261. — De Gorter, Medicinie Compendium, 1731.
— Winter, De Certitudine in Med. Pract., lUiQ. — Holier,
Deux M6moiies sur les Parties Sensibles et Irritables.
Lausanne, 1756 ; et Elementa Physiol., 1. iv. et 1. li. — Zim-
merman, De Irritabilitate, &c., 1751. — Bordeu, Recherches
Anat. sur les Glandes, &c. Paris, 1751. — Senac, De la
Structure de Coeur, &c. Paris, 1749. — Whytt, Physiol.
Essays. Edin., 1755 ; Works, <fec., p. 27i. — De Hae'n, De
Sensibilit. et Irritabil. Hum. Corp., 8vo, 1761. — Battie, De
Princip. Anim. Exercit. London, 4to, 1757. — Farr, on An-
imal Motion, <fec. Lond., 1771. — Monro, Structure and
Functions of the Nerv. System, fol. ed., 1833. — J. Brown,
Elementa Medicinae, cap. 11, 12.— G. Blane, On Muscular
Motion, Philos. Trans., 1788. — Cruickshank, Philosoph.
Trans., 1795. — J. L. Gautier, De Irritabilitatis Notione,
Natura et Morbis, 8vo. Hall., 1793 ; et Physioloerie und
Pathologie der Reizbarkeit, 8vo. Leips., 1796. — E. B. G.
Hebenstreit, Doct. Physiol, de Turgore vitale brevis Expo-
sitio, 4to. Lips., 1795. — G. Prochaska, De Carne Muscu-
lari. Opera Minora Anat. Physiol, et Pathol., <fec., vol. i.
Vien., 1800 ; et Bemerk. ueber den Organismus d. m. Kor-
pers, 8vo. Wien., 1810. — G. R. Treviranus, Ueber Leben-
sturgescenz, in Phys. Fragm., th. i., s. 57-102.— J. Gregory,
Conspect. Med. Theoreticae, <fcc., passim. — Legallois, Ex-
periences sur le Principe de la Vie, p. xvi. — Bichat, Re-
cherches sur la Vie et la Mort. Paris, 8vo, passim : et
Anatomic G6n6rale, 8vo. Paris, passim. — J. Copland, \n
Lond. Med. Repos., vol. xvi.,p. 370. — Richerand, Elements
of Physiology, &c., with Notes and Appendix, by J. Cop-
land, 8vo. Lond., 1824, and edit. 1829.— Fournier et Begin,
in Diet, des Scienc. M6d., t. xxvi., p. 9i.—Adelon, Physi-
ologie de I'Homme, 4 vols., 8vo. Paris edit., 1829, passim.
— D. B. Mojon, Laws of Physiology ; trans, by G. R. Skene,
8vo. Lond., 1827.— R. A. Rudolphi, Elements of Physiolo-
gy, &c. ; trans, by W. D. How, 8vo. Lond., 1825, p. 207.—
M.Hall, Phil. Trans., 1833. — F. Tiedemann, Systematic
Treatise on Comparat. Physiol, &c. ; trans, by J. M. Gully
and J. H. Lane, &c., 8vo. Lond., 1834, p. 289.-7. Miiller,
Elements of Physiology ; trans, by W. Baly, 8vo. Lond.,
1840, vol. i., passim. — (A. Walker), Documents and Dates
of Modern Discoveries in the Nervous System, 8vo. Lond.,
1839, p. 155. — {See, also, the numerous recent works on Phys-
iology.)

IRRITATION.— Syn. OpyacT/xoc, epedia/xoc, Gr.
Trritatio, Irritamentum, Lat. Reizung, Germ.
Irritazione, Ital.

Classif. — General Pathology — Special
Pathology and Therapeutics.

1. Defin. An exaltation of the vital actions of
a -particular tissiie or system relatively to the vital
states of other parts.

2. I. Preliminary Remarks. — Next to in-
ftammation, the morbid condition to which the
term irritation has been applied is the most im-
portant, both to the pathologist and to the ra-
tional practitioner. Notwithstanding this, the
term has been vaguely employed, and the ex-
istence of the morbid states which it has been
used to designate has been as loosely inferred.
This has arisen, in a great measure, from the
neglect of these states, until a comparatively
recent period, by most writers on general and
special pathology ; from the want of any pre-
cise ideas respecting the nature, extent, and
relations of the morbid actions to which the
term irritation is applicable ; and from the dif-
ficulty of determining the modes, grades, tran-
sitions, and consequences which these actions
experience. The varying characters, also, of
irritation with the tissue or part primarily or
chiefly affected, and with lesions of adjoining
or of functionally associated parts, and the su-
perinduction of other morbid changes, more
particularly of increased exhalation, secretion,
and inflammatory action, have given rise to
much perplexity, in respect not only of the

meaning attached to the word, but also of at-
tempts of ascertaining its existence, seat, and
extent. Hitherto irritation, as a primary mor-
bid condition, has been inferred more frequent-
ly from the absence, during disease, of more
manifest alterations than from any positive
proof of its presence ; and to it have been re-
ferred by many those disorders and maladies
which could not be imputed to any more palpa-
ble lesion.

3. It has been shown, in the article Irrita-
bility, 1st. That irritability is the chief mani-
festation or expression of life in the tissues and
organs of a living body. 2d. That it exists in
various grades and modes, according to the or-
ganization and connexions of different textures
and systems, the functions of organs being dis-
charged in great measure by such agencies.
3d. That the modes and grades of this property
ascend from simple vital cohesion up to that
form of muscular contractility which is deter-
mined and regulated by the will.* 4th. That
in this, its highest grade, it interests and is as-
sociated with conscious sensibility.! 5th. That
it is variously affected by the states and chan-
ges of the nervous system, more particularly
by the organic or vital nervous system, and by
the conditions of the blood. 6th. And that such
affections constitute the principal alterations in
numerous constitutional maladies.

4. To these fundamental principles of pathol-
ogy, which were fully developed by me many
years ago {London Med. Repository, vol. xvii.),
others may be added, having a stricter refer-
ence to the subject now under consideration.
The grades and modes of irritability thus vary
not only in different organs or parts, but also
in different epochs of life, in different tempera-
ments and habits of body, and under the influ-
ence of numerous physical agents and various
moral influences. Depending, as it does, upon
the amount or condition of vitality, so it must
necessarily vary with the states of this actua-
ting and controlling principle. Where this prin-
ciple is powerfully or largely imparted, irrita-
bility will also be energetically evinced, and
long exerted ; but where life is depressed, ex-
hausted, or feeble from the earliest endowment
of it in the structures, then irritability will be
feebly expressed, readily excited in its highest
grades, and speedily dissipated. With weak-
ness or vital depression, irritability becomes
more easily roused — the susceptibility increas-
ed — or, in other words, the disposition to con-
tract upon the application of irritants is great-
er ; but the contractions are weaker, and the
sooner cease altogether. Yet this increased
susceptibility of parts thus weakly endowed is
not general, and exists chiefly in parts which
manifest the higher grades of irritability.

5. Another important circumstance which

* " The lower grades of contractility depend entirely upon
the organic or ganglial nervous system and influence ; the
highest form ouly upon the supei^addition of the nervous
system of voluntary motion and sensation." — (Author's
Physiol., Notes on.)

t " Conscious Sensibility is confined chiefly to certain
parts and textures of the body, and is dependant npim the
part of the nervous system of which the encephalon is the
centre. Contractility exists t'liroughout the whole animal
structures, although in different grades, and is, with the
exception of its hiijhost grade or species, entirely indepeml
ent of sensibility and volition : contractility is a general ex-
pression of life, sensiliility of the higher functions ouly of
this principle." — {Notes, &c,)

IRRITATION— Pathological Relations oP.

697

may be noticed is the increased disposition of
local irritation to extend itself in proportion to
the increase of susceptibility, or, in other words,
to the diminution of vital power. This aug-
mented disposition to the extension of irrita-
tion, and to the manifestation of several of its
effects in different and remote parts, evidently
depends upon the same primary condition to
which I have attributed increased susceptibili-
ty, namely, weakened organic nervous energy
or vital power. Hence an increased disposi-
tion to be affected by irritants generally is asso-
ciated also with a disposition to extend their
effects to distant parts. The extension of irri-
tation, or, rather, of its effects, far beyond its
primary seat, evidently depends upon, or, rath-
er, takes place through the medium of the or-
ganic or vital and the cerebro-spinal nervous
systems, the former especially ; but this topic
will be more fully considered hereafter.

6. Illustrations of the foregoing pathological
facts are daily presented in practice. We con-
tinually observe, in persons originally and or-
ganically feeble, in those who have become fee-
ble from the exhaustion consequent upon ex-
cessive or repeated excitement, and in those
depressed by disease, all contractile parts, more
particularly muscular structures, to be readily
acted on by irritants, especially by such as are
novel ; but the excited action is weak, or is
soon exhausted, and rapidly sinks the principle
upon which the contractility depends. In con-
nexion, also, with this local susceptibility, an
increased disposition to experience the effects
of the local and primary irritation in distant
parts is also developed ; and these distant parts
often manifest the principal amount of disor-
der, evincing both its nature and primary seat.
In these cases, irritable parts become more
susceptible of irritation, or morbidly irritable,
not only locally, but generally also, as respects
the nervous systems, especially the organic
tervous system, upon which the several grades
of irritability have been shown to depend. And
here it should be recollected that the term irri-
table admits of two meanings, which should
not be confounded with each other : some parts
are naturally and healthily irritable ; and these,
as well as some other parts, become morbidly
irritable, owing to numerous causes — to excess
or deficiency of stimuli, to the operation of nox-
ious agents, or of most of the causes of disease
A morbid state of irritability may be either
more or less local or limited, or extended and
constitutional ; but in either case, the suscep-
tibility of contraction is increased, while the
power and duration of it are the sooner ex-
iiausted. Mr. Hunter defined morbid irritabil-
ity to be " an increased disposition to act with-
out the power to act with," with much truth,
although with insufficient precision ; but it will
generally be found, as I have just stated, that
the amount and duration o{'^powcr^' will bo de-
ficient in proportion to the " increased disposi-
tion." In all cases of morbid irritability, wheth-
er local or constitutional, the intrinsic and ex-
trinsic causes and circumstances connected
with it should be considered; and tliis state,
moreover, ought to be carefully distinguished
from irritation ; for the former may exist with-
out the latter, owing to vital depression merely,
or to this state associated with others ; and the
latter may be induced and continued by local
II. 88

agents, where the former can hardly be said to
be present, more particularly witii reference to
the constitution generally. Physically as well
as morally, irritation may be caused, and yet
morbid irritability may not be present, although
the one will favour and aggravate the other
mutually. Both states are frequently associa-
ted, but they are not necessarily connected.

7. II. Of the Pathological Relations of
Irritation. — If an irritant or stimulus act upon
a living tissue or organ, certain changes, hav-
ing reference to the nature of the functions
discharged by the tissue or organ which is act-
ed upon, and to the properties of the agent em-
ployed, are thereby produced. If the digestive
canal be acted upon by one particular irritant,
certain of its actions are augmented or modifi-
ed ; if a different irritant is employed, others
of these actions are increased ; and if the irri-
tant be more powerful or in excess, the effects
are locally heightened and extended to remote
parts. If the external structures and organs
be irritated, sensibility is excited, and all the
functions of the part more or less increased or
otherwise affected. Whatever may be the func-
tion of a part, such function will be exalted by
a moderate irritant ; but it will be disordered,
or even overturned altogether, by an excessive
one, owing to the effects thereby produced in
the circulation and organization of the part upon
which the irritant has acted. Seeing that the
operation of irritants is thus different as re-
spects their actions individually, and as regards
the tissues chiefly affected by them, and, con-
sequently, that irritation is various in its char-
acters, extent, relations, and consequences, ac-
cording to its cause and seat, it becomes requi-
site to the due investigation of this important
department of pathology to analyze it more
fully.

8. i. Relations of Irritation to the Ner-
vous Svste.ms. — A. To the Organic or Vital Ner-
vous System. — The vital actions of a part, and
contractility in particular, have been shown,
both here and in the places already referred to,
to depend upon this system. When a tissue
is irritated, these actions are affected, and it
may therefore be reasonably inferred that the
cause of irritation acts chiefly upon the system
by means of which these actions are produced,
and that, in consequence of changes in the parts
of this system distributed to the tissue or struc-
ture which is irritated, the effects of irritation
are developed. If a portion of the intestinal
canal be irritated, either by mechanical or chem-
ical stimuli, its contractility is first augmented.
If the irritating cause, or the irritation, howev-
er excited, continue for a time, the secreting
functions and the circulation are affected ; and
if it be energetic or excessive, these are still
more increased, and sensibility, so obscurely
bestowed on this part, i« acutely roused. In
addition, also, to these changes, the irritation,
which was limited, while it was slight, to the
parts more immediately subjected to its causes,
now extends itself, influencing different sys-
tems and parts ; and, owing to the connexions
of the organic nervous system with the cere-
bro-spinal, not only is sensation acutely affect-
ed, but also the contractions of voluntary mus-
cles are violently excited, without either the
influence or the control of the will.

9. Irritation thus originating in parts endovp-

698

IRRITATION — Pathological Relations of.

ed chiefly by tne organic or vital nervous in-
fluence, will either continue more or less limited
in i/s sphere, or extend itself to various parts, ac-
cording to the general susceptibility of this sys-
tem, to the predisposition or susceptibility of
particular organs, and to various concurring or
determining causes. — a. Where the irritation
is slight relatively to the amount of organic
nervous power, or where the susceptibility is
not increased, the limitation of it to its original
seat may be long continued ; but where it is
more considerable, organic nervous power be-
ing low, and the susceptibility, either general
or local, consequently high, it will extend itself,
or manifest its effects, more or less prominent-
ly, in remote situations. The limitation of irri-
tation may be so complete that one function
only of one organ is affected ; but this seldom
is of long duration without other functions and
organs experiencing disorder. Thus, owing to
mental emotion acting as an excitement to the
cardiac nerves, palpitation or excessive action
of the heart is produced ; and in consequence
of the irruption of bile into the intestines, in-
creased action of their coats is occasioned ; but
this discharge seldom is great or continued
without producing augmented secretion from
the intestinal mucous surfaces generally, and
increased determination of blood and other
changes of the vascular system, consecutively,
as will be hereafter shown.

10. b. The extension of irritation, particularly
when seated in an internal or vital part or vis-
cus, takes place either directly, by means of the
communicating ramifications of the organic or
ganglial nervous system, or indirectly, and by a
reflex operation of the ganglial nerves, convey-
ing the morbid impression or action to the roots
of the spinal nerves, or to the spinal cord and
brain, and thereby exciting the sensations or
actions of parts supplied with nerves by the
cerebro-spinal system, or in both these modes,
either consecutively or contemporaneously.
These two distinct ways, by which irritations
or impressions are transmitted to parts remote
from the seat of impression, were pointed out
by me many years ago, and described by the
terms direct and reflex sympathy. (See Physio-
logical Notes, &c., 1824.)

11. a. The direct transmission of irritation
may take place either along parts or tissues
similarly constituted, as mucous or serous tis-
sues, or from one organ to another, by means
of the organic nerves with which they are sup-
plied. In this manner, irritation of one part of
the intestinal mucous surface often proceeds
along it ; or irritation of one part of the mus-
cular coats of the bowels frequently extends
along the tube, or affects it to a greater or less
extent, as in colic and hysteria. The morbid
impression, also, made upon the organic or vi-
tal nerves of one tissue or viscus, is often
transmitted thence to an adjoining, but differ-
ently constituted organ, through the medium
of these nerves, winch are supplied to both.
Thus the irritants which affect the nerves of
the duodenum or of the stomach primarily, ex-
tend their operation in many cases also to the
liver and pancreas ; and stimuli which excite
the stomach raise the action of the heart and
vascular system. Irritants of the kidneys fre-
quently render the urinary bladder more irrita-
ble, or excite this latter viscus ; and those of

the rectum often extend their influence to both
the urinary and genital organs. In cases of
this description, it may be asked whether irri-
tants or stimuli applied to an involuntary part
excite the contractions and vital actions of such
part by producing an impression on the organic
nerves which is conveyed to their correspond-
ing ganglia, and reflected thence by these nerves
upon the muscular fibres which they actuate ;
or M'hether they act directly, and without the
intervention of the ganglia, independently of
any reflex operation, and simply by affecting
the state of the nerves themselves — by afTect-
ing the organic corpuscles and fibrils entering
into the organization of the part. I would in-
cline to this latter alternative ; although I ad-
mit that the ganglia may generate an addition-
al vital influence, re-enforcing that with which
the tissues and organs are endowed. The
truth of this inference is confirmed by the fact,
often observed by me and others, that involun-
tary contractile parts, as the heart and portions
of the intestinal canal, may be excited to con-
traction even when removed from their con-
nexions with the ganglia.

12. j3. As I have shown, when treating of
various diseases originating in the nervous sys-
tem, irritations commencing in the organic
nervous system are often propagated to the
cerebro-spinal system, and thence reflected upon
external and distant parts, either affecting the
nerves of sensation, morbid sensation or pain
being felt in parts to which such nerves are
distributed, or exciting those of voluntary mo-
tion, so as to remove them out of the due control
of the will. In this manner I explained, in the
early parts of the work (published in 1832 and
1833), the origin of several spasmodic and con-
vulsive diseases ; and insisted that the irrita-
tion thus conveyed to the roots of the spinal
nerves, by means of the communicating rami-
fications of the gray or ganglial nerves, either
might reach the spinal chord and brain, thereby
exciting involuntary or automatic motions of
involuntary parts and conscious sensation, or
might affect the nerves of motion and sensa-
tion, and the parts supplied by them ; the cer-
ebro-spinal axis being only contingently impli-
cated.*

13. B. Relations of Irritation to the Cerebro-
spinal Nervous System. — That irritation of a
part, as of an extremity, will excite contrac-
tions of the muscles of the same or of an adjoin-
ing part, independently of sensation or of the
intervention of the brain, has been illustrated
by Dr. M. Hall ; but, instead of attributing this
to a '^reflex function," as he has done, it may
be explained as I have many years ago at-
tempted, in a work already referred to, by
means of a '^reflex sympathy." Dr. Hall and
Mr. Grainger, in endeavouring to establish the
existence of this as a distinct function, have
attempted to connect it with a particular or-
ganization of the spinal chord ; and to show
that there are not only nerves of sensation and
voluntary motion, which have an intimate con-
nexion with the brain, and are actuated by it,

* The reader is referred to the articles Cholera, <i 23,
Chorea, ^ 16, and Convulsions, t) 42--46, the last espe-
cially. iiT remarks upon rejleclcd irritation, which were
Written in IR'iO and 1831, and puhlished in 1832, long be-
fore the appearaiicfi of Ur. M. Hall's views on the sulijecti
aud explained by him by means of a " reflex function"

IRRITATION— Pathological Relations of.

699

but also a distinct class of nerves which are
independent of this organ, and arise from the
spinal chord. This class he has denominated
the " excito-mptory" and " reflecto-motory"
nerves. Dr. Hall limits the phenomena of re-
flex action to this class of nerves, and denies
the cerebral nerves of special sense the power
of producing them. He supposes the reflex
motor actions to be in no case excited by sen-
sation, nor even by means of the sensitive ner-
vous fibres. He maintains the existence of
spinal nerves, endowed with the " excito-moto-
ry" function ; and the reflex action he supposes
to be conveyed, not by the nerves of sponta-
neous motion, but by special fibres, which he
calls " reflecto-motory." This theory of ex-
cited and reflex movements being produced by
nervous fibres which are distinct from those
which reach the centres of sensibility and voli-
tion in the brain, has been supported by Mr.
Grainger and Dr. Carpenter. The former
believes that the fibres of the roots of the spi-
nal nerves, which pass into the chord, and are
lost in the gray matter, as demonstrated by
Weber, Bellingeri, and himself, are the true
excito-motory and reflecto-motory fibres. Such
may or may not be the case ; or the nerves
which thus originate in the gray matter of the
chord may be destined to transmit to the gang-
lial system the influence generated by this part
of the chord, thereby re-enforcing, and, in cer-
tain places or ganglia, modifying the influence
proceeding from the organic nervous system
itself Thus, the ganglia supplying the heart,
the genital organs, and the outlets of mucous
canals, are re-enforced by nerves from the spi-
nal chord ; and it seems much more probable
that the gray matter of the chord gives origin
to them, and generates an influence necessary
to the due performance of the functions of
these parts, than that it gives origin to a class
of nerves, the existence of which, as well as
of their imputed functions, is altogether hypo-
thetical.

14. The chief phenomena adduced in favour
of an " excito-reflecto-motory" function, of its
independence of sensation, and af the gray
matter of tlie cliord giving origin to nerves
destined to perform this function, are : 1st. That
reptiles and various others of the lower ani-
mals, when decapitated, may still evince mo-
tion of a part when its surface is irritated ;
2d. That an apoplectic or paralyzed person may
retract or move the paralyzed limb when it is
pinched ; and, 3d. That infants, when asleep,
may clinch their hands when the palms are ir-
ritated. The same explanation applies to these
several phenomena. But as long as they ad-
mit of explanation without calling into our aid
the existence of a new and special apparatus
for this purpose, the material presence of which
is not demonstrated or even rendered probable,
we are bound to refer them to the organization
which is generally admitted, as parts of the
offices discharged by it. In reptiles, and even
in higher orders of animals, it has not been
ascertained how far sensation is extended
throughout the nervous system, or how closely
it is confined to the brain, or the ganglia serv-
ing the oflices of the brain. The distinctions,
moreover, existing between conscious and in-
conscious sensations have never been attempt-
ed to be drawn ; unless, indeed, in the brief

manner I have attempted, many years ago, in
my physiological notes. That the brain is the
seat of conscious sensation, in the higher ani-
mals especially, will not be denied ; but that a
species of sensation — a susceptibility of motion
and action, particularly of such motions and
actions as have become habitual, is retained
and exerted under the influence of certain stim-
uli or irritants, when the brain is no longer
conscious, or even after its removal in young
or in the lower animals, cannot be doubted.
The mere turning in bed while a person is
soundly asleep is a proof of this ; and the mo-
tions of a limb, upon irritation of it, in apoplexy
or in paralysis, is of a similar description. In
these cases, the brain is not in a condition to
manifest consciousness ; but, with the rest of
the nervous system, it may still be so impress-
ed by an obscure feeling of uneasiness as to
give rise to motion or change of position.
The explanation given of these phenomena by
Dr. M. Hall would have been more convincing
if a different one equally, if not more conclu-
sive, could not have been ofl^ered. For, if the
facts and arguments adduced in the article
Irritability, and elsewhere, be received, it
will necessarily follow that the irritation of
parts acted on by volition will give rise to con-
tractions of them, as in involuntary parts ;
seeing that the nerves of volition are merely
superadded, in the former, to the organic or
ganglial nerves, which supply them in common
with all other contractile parts ; and that con-
tractions will thus take place in them independ-
ently of the transmission of the irritation by
means of excitory fibres to the chord, in order
to be reflected back again by means of other
fibres. Even granting that the irritation is
conveyed by nerves of sensation, it does not
follow that it shall reach the chord itself, for it
may only proceed as far as the ganglia on the
roots of the nerves, and there partially affect
the motory fibres corresponding with the sensi-
tive fibres, without giving rise to conscious
sensation.

15. Moreover, as the nerves of general and
special sensation may be viewed as originating
in the tissues and organs they actuate, and the
parts they endoiv, as shown to be the case in re-
spect of the organic or vital nerves, and as
converging to the spino-cerebral axis — being,
in fact, centripetal nerves — it may reasonably
be expected that irritation of a part will often
give rise to motions of corresponding or asso-
ciated parts, without the brain, or even the
spinal chord, under certain circumstances, co-
operating in the act, or taking cognizance of it.
These nerves are thus expanded in the tissues
and organs, so that an impression or irritation
in any one point, however minute, is trans-
mitted from them to the central organs of per-
ception and volition, where it gives rise to con-
scious sensation, if it be sufficiently strong,
and if these organs be in a state capable of dis-
charging these functions ; but when they are
incapable of consciousness, as in sleep, apo-
plexy, &c., or when the impression is so weak
as not to excite this function, still motions of
voluntary muscles may follow, owing to " re-
flex sympathy" as explained in my Physiological
Notes, already referred to. When the bronchial
secretion rises to the larynx, it there irritates
the nerves of sensation supplying this part i

700

IRRITATION— Pathological Relations of

and the irritation, if the patient be awake, gen-
erally becomes an object of consciousness, giv-
ing rise at the same time, and by a reflex
sympathy, to increased or spasmodic action
of the muscles of respiration : in such cases, as
I have pointed out in my "Notes," the irritation
is conveyed by the nerves of sensation to the
cerebro-spinal axis, and thence reflected by the
associated nerves of motion upon the muscular
apparatus which the latter nerves supply. In
many of these instances, the reflected motions,
consequent upon the irritation, take place, al-
though in a much less degree, when the brain
is incapable, as in sleep, of taking due cogni-
zance of the primary irritation ; yet this is no
sufficient proof, either that the brain is unne-
cessary to their production, or that the spinal
chord alone performs them, or that a particular
organization of both the chord and nervous
system is destined for their performance. In
the particular illustration now adduced, it is
just as probable that the irritation excites the
nerves of motion, independently of both brain
and spinal chord, as that it acts through the in-
tervention of one or both of them. To infer,
then, that the chord contains, or is the centre
of an apparatus destined to discharge certain
offices, which offices may be readily performed
by the agencies, and in the modes previously
conceived, and which consist merely of the re-
ception and transmission of irritation or ex-
citement, by sensitive and organic nerves, and
reflecting such irritation by means of motory
nerves upon voluntary muscles — the gray mat-
ter of the chord receiving the fibres supposed
to convey the irritation, and originating those
transmitting or reflecting it upon the muscles —
is to suppose the existence of an organization
too important for the amount of function to be
performed — is to assign a means of much too
wide and great extent, for a contingent or an
occasional office ; and one, moreover, of the
existence of which there is no visible, or pal-
pable, or demonstrative proof

16. If the apparatus argued for by Dr. M.
Hall and Mr. Grainger really did exist, no
reflex action could possibly occur when the
spinal chord is destroyed ; yet, nevertheless,
the destruction of the chord could not be a sat-
isfactory proof that reflex actions depend sole-
ly on it, seeing that the vitality of the animal
receives such a shock from an injury so very
extensive as this, as would prevent these ac-
tions from being manifested. Indeed, some
experiments which I have made induce me to
infer that reflex motion may take place inde-
pendently of the spinal chord itself, and by
means of the connexions subsisting between
sensitive and motive nervous fibres, in the vari-
ous ganglia and plexusus, and that the isolation
•of those and all other sympathetic actions in a
single part contended for by these writers is
not consistent with the connected and recipro-
cative functions of the different parts of the
nervous system. Moreover, it should be recol-
lected that it is not motion alone that is thus
reflected from the seats of irritation. In some
cases, more especially when the irritating cause
afl^ects the organic nerves, or when parts chiefly
supplied with them are affected, pain or morbid
sensibility, either alone or in connexion with
disordered muscular action, is manifested in
remote or corresponding parts. Hysteria and

various spasmodic affections furnish sufficient
illustrations of this.

17. In convulsive and spasmodic diseases,
which have received specific but conventional
appellations according to the forms they as-
sume, we observe that irritation of sensitive
and ganglial nerves gives rise to abnormal ac-
tions of the muscles, without any sufficient
proof being furnished of the spinal chord being
actively engaged in the circle of morbid action ;
and when the spinal chord or its membranes
have presented any lesion after death from
these diseases, there is every reason to infer
that such lesion was merely an occasional
contingency, the irritation being conveyed by
these nerves to the plexuses and roots of the
motory nerves, and reflected thence by the lat-
ter nerves upon the muscles, without the spinal
chord being necessarily brought within the
sphere of morbid action.

18. Irritation, therefore, whether of sensitive
or of organic nerves, gives rise, in the crebro-
spinal nervous system, owing either to the prop-
agation of the morbid impression in a direct
manner, or to the transmission of it in the first
instance to the roots of the spinal nerves, or to
the spinal chord itself, and the reflection of it
thence, 1st. To spasmodic or convulsive actions
of voluntary muscles, as shown in the articles
Chorea, Cholera, Convulsions, Disease, &c. ;
2d. To pai)i or altered sensibility of some part
of the surface of the body, or of particular
nerves, or of a limb. Irritation, also, of one
portion of the cerebro-spinal nervous system
may directly affect distant parts, or indirectly or
mediately and by a rcflexed sympathy , as already
mentioned. When the irritating cause is in the
brain or medulla oblongata, the functions of
sensation and perception may be deranged, ei-
ther solely, or in connexion with morbid voli-
tion and muscular action or motion. In such
cases, the irritation is central, its effect direct
and immediate, and manifested chiefly in the
functions performed by, or intimately connected
with the tissue most seriously affected. When
the irritation is seated in the spinal chord, and
is unattended by effusion or other cause of
pressure on the chord, muscular action only
may be excited, but generally excited in such
a manner, or to such an extent, as to be no
longer amenable, or to be imperfectly amenable
to the control of the will ; or sensation only
may be affected in various grades, the spinal
irritation manifesting itself in the ramifications
of sensitive nerves, and the morbid sensation
becoming an object of consciousness through
the instrumentality of the medulla oblongata
and brain ; or both muscular action and sensi-
bility may be conjointly disordered. Illustra-
tions of irritation of the central parts of the
nervous system are constantly appearing in
practice. When irritation is seated in portions
of the gray or effective portions of the brain,
the states of the mind, the sensations, and spe-
cial functions of sense are chiefly disordered.
When it extends to or affects the fibrous struc-
ture, muscular actions are deranged. When it
commences in the medulla oblongata, general
sensibility, the respiratory functions, and volun-
tary motion are disordered, according to the
extent and grade of the primary morbid condi-
tion. When it implicates the spinal chord, the
consequences vary with its seat, or as the gray

IRRITATION— Pathological Relations of.

701

or fibrous structure, or the anterior or posterior
columns are solely or chiefly affected by it.

19. It has lately been supposed, as above
stated, that the sympathies which 1 have called
reflex, and those irritations which are propa-
gated to the spinal chord, and reflected thence
to remote parts of the external surface or to
the extremities, with the tonic contractions of
the sphincters, are essentially dependant upon
the gray substance of the chord ; but there is
much more reason to believe that this substance
is chiefly concerned in generating an influence
necessary to re-enforce and increase that pro-
duced by the ganglial nervous system ; and that
this influence is conveyed by nervous fibres to
the plexuses and ganglia of this system, and to
the muscles of voluntary motion. Irritation,
therefore, of the gray tissue of the spinal chord
will thus affect the thoracic and abdominal vis-
cera obscurely, indirectly, and through the me-
dium of the ganglial system ; but more directly
and obviously the muscles of voluntary motion,
the actions of which will be thereby removed
more or less from under the control of the will,
and thus become involuntary or automatic. It
is very probable that the continued action of the
sphincters very much depends upon this part
of the chord ; but in this case the action is di-
rect — is immediately dependant upon this or-
ganization, and not merely reflex ; but it may
be allowed that, in common with all other mus-
cular actions admitting of being influenced by
volition, irritation in the vicinity of sphincters
will induce, both directly and indirectly, as
above explained, increased contraction of the
sphincters.

20. It has likewise been supposed that the
spinal chord, and more especially the gray sub-
stance of it, is the source of irritability. I
have already ascribed this very important, and,
indeed, chief manifestation of life, to the or-
ganic or ganglial nervous system, whether as
manifested in the voluntary or in the involun-
tary muscles — in hollow muscles or in sphinc-
ters ; the fibres proceeding from the spinal
chord conveying the influence generated in this
quarter to these parts, and re-enforcing, in-
creasing, or otherwise influencing that which
is produced by the ganglial system ; this latter
system being, however, the chief source of the
tone and irritability of these several orders of
muscles. It is, moreover, very probable, al-
though the fact cannot be satisfactorily demon-
strated by experiment, that the gray matter of
the chord is that part only which generates
the power thus destined to re-enforce and in-
crease the power conferred by the organic or
ganglial system, and especially to augment the
energy which the ganglial system confers upon
the generative organs. Thus, while these or-
gans have large ganglia and plexuses of organic
or vital nerves (of gray and non-tubular fibres),
with large communicating branches running
between them and the other ganglia, very con-
siderable branches of nerves (of white tubular
nerves) are also sent from the sacral spinal
nerves ; but, instead of ramifying directly in
these organs, they always proceed by the most
immediate or direct routes to the ganglia which
supply these organs. The sphincters, also, are
supplied with organic or ganglial nerves, and
•with spinal nerves ; the latter, however, par-
ticularly as respects the sphincter ani, 6cc.,

proceeding directly to this muscle ; so that, al-
though the tonic contractions of the sphincters
depend upon the organic nerves, these contrac-
tions may be exalted by volition, through the
instrumentality of the spinal nerves.

21. Whatever energy may thus be supplied
by the spinal chord to the genital organs and
sphincters is most probably generated by the
gray substance of the chord, while the will
merely stimulates this energy, and develops it
in a more or less active and sensible manner.
If we analyze the phenomena manifested by
the generative organs, we shall find that the
essentially vital and insensible changes and
functions of these organs are dependant upon
the organic nerves with which they are so
abundantly supplied, and upon the connexion
of these with the rest of this system ; while
the excitation of these functions, and the sen-
sible changes attending such excitation, take
place through the medium of the organization
of the spinal chord and of the nerves proceed-
ing from it. The former of these classes of
phenomena require little remark, farther than
that they are performed with a degree of per-
fection proportionate to the strength and con-
stitution of the individual. The latter phenom-
ena are produced in one or other of two modes
— either by the influence of the mind upon
the nerves of these organs, through the medi-
um of the chord, or by the local irritation of
these nerves ; the influence of such irritation
extending not only to all these organs, but also
to the spinal chord, and to the brain, whence
it may be again reflected back upon them and
upon other parts.

22. While thus the tone, irritability, and
strength of contractile and sensitive parts are
furnished by the organic nervous system, and
augmented by the influence generated by the
gray substance of the chord, irritation, impli-
cating either of these parts of the nervous or-
ganization, excites and removes from under
the control of the will the functions of the parts
which receive nerves from the part irritated ;
and while irritation of the parts giving origin
to nerves necessarily exalts the functions per-
formed by these nerves, whether these be sen-
sitive or motory, yet, if it be either carried to
too high a grade, or continued too long, vital
exhaustion will succeed. The vital tone and
irritability of contractile parts will also be ex-
hausted by the excitement caused by volition,
when either energetic or prolonged beyond
what is necessary to the healthy development
of these functions.

23. ii. Relations of Irritation to, and In-
fluence ON, THE Vascular System and Blood.
— There can be no doubt of the commence-
ment of many of the diseases, both local and
constitutional, of which the vascular system is
the scat, in the nerves, more especially in the
ganglial or vital nerves supplying this system,
and the several tissues and secreting struc-
tures. I have attempted to show that this must
necessarily be the case in respect of many mal-
adies, both in the article on Disease generally,
and in those on specific affections. At the
same time, I have not only admitted, but even
demonstrated, that the blood may be either pri-
marily or consecutively altered from its healthy
constitution ; and that it may, moreover, pre-
sent such states as, although they may not

702

IRRITATION — Pathological Relations op.

amount to actual disease, may strongly predis-
pose to it, and contribute much to the develop-
ment of it, as soon as the nervous system is
subjected to any shock, irritation, or morbid
impression ; or as soon as some vital, or se-
creting, or excreting viscus experiences any
interruption of its functions ; the morbid con-
dition of the blood, in its turn, affecting the
nervous systems of organic and animal life, and
exasperating or perpetuating disorders primari-
ly seated in these systems.

24. The influence of irritation on the vascu-
lar system is well demonstrated by the changes
consequent upon irritating the nerves of erect-
ile, glandular, and mucous tissues. We ob-
serve excitement of the nerves of these parts
produce expansion of the capillaries, increased
action of the arteries, and turgidity of the veins.
The irritation is thus generally followed by
what has been variously denominated turgor
vitalis, vascular turgesccnce, vital turgesccnce,
&c. ; and this condition, especially when fa-
voured by the tissue, as in irritation of mu-
cous surfaces, or by the temperament, consti-
tution, or diathesis, or by states of the blood,
may readily pass into active congestion or deter-
mination of blood — its common consequence ;
or into inflammation, or sub-inflammation ; or
it may give rise to haemorrhage. As respects
mucous surfaces, cellular tissues, and glandular
structures, the usual consequences of irritation
are increased exhalation, secretion, and vascu-
lar determination or flux ; which, if allowed to
proceed, or if the irritating cause act violently,
is followed by some state or other of inflamma-
tory action and its various consequences.

25. A. The relations of irritation to the several
states of ivflammation are more intimate than
have been generally admitted by pathologists.
Irritation seated in any tissue, or in a secreting
surface or organ, can be viewed, at its com-
mencement, only as connected with the nerves
of the part ; and in this stage, as well as in
those which follow, it is attended by more or
less of altered sensibility. In some structures,
morbid sensation may be the chief disorder
throughout its course ; but in parts which per-
form a secreting function, or which are highly
vascular, augmented and otherwise altered se-
cretion, and increased vascular determination
and action, very generally supervene. In se-
creting surfaces and glands, an augmented flow
of their natural products usually follows the
commencement of irritation ; and, as the irri-
tation proceeds, or as it increases, these prod-
ucts generally become not only augmented in
quantity, hut also changed in quality ; and the
vascular determination also is increased, or it
assumes an inflammatory form, or one very
closely allied to the more chronic or sub-acute
forms of inflammation, several of the changes
usually consequent upon inflammation also ap-
pearing in the advanced progress of the disor-
der, thus originating in, and chiefly consisting of,
irritation in its earlier stages. Diarrhoea, from
irritating ingesta, or from cold and simple ca-
tarrh, or catarrhal bronchitis, often furnish il-
lustrations of this course of morbid action ; and
the more simple, as well as the more complex
of the glandular structures, are liable to similar
changes. A disorder of function, consisting
of irritation or exaltation of the organic ner-
vous endowment of the part, is gradually con-

verted into structural disease, owing to this
disorder having affected the secreting, and con-
secutively the circulating functions, morbid
capillary and arterial action ultimately passing
into organic change. Many of the forms of in-
flammation, particularly those which are chron-
ic and sub-acute, originate in irritation, or in a
change in the state of the organic nervous in-
fluence of the part, the liability to the vascular
disease, as well as the grade of action, depend-
ing upon the susceptibility of the system in
connexion with the state of the blood, and with
the nature of the tissue or structure in which
the irritation is seated.

26. B. The relations of irritation to hemorrha-
ges a7id serous effusions are very similar to those
just instanced in respect of inflammations.
The irritation which in one constitution would
produce some form of the latter will produce
in others some one of the former, the particu-
lar effect being, in a great degree, influenced
by the states of organic, nervous, or vital pow-
er, of the irritability of capillary tone, and of
the blood ; these states themselves being, in
some measure, dependant upon those viscera
chiefly engaged in the functions of assimilation
and excretion ; or, in other words, these sev-
eral morbid conditions often acknowledging
one source, namely, the state of the vital ner-
vous influence. Haemorrhages, particularly those
taking place from mucous surfaces, are often
traceable to local irritation, in connexion with
impaired tone of the extreme capillaries, and
often with vascular plethora ; but something
is also to be imputed to the constitution, or in-
dividual conformation, as shown by the dis-
tinctive characters by which it is marked, and
by its hereditary disposition. Many of the
phenomena, also, preceding haemorrhage, as
well as some of those attending it, are referri-
hle to irritation, this primary morbid condition
of the organic nerves of the part influencing
the states of vascular determination and action
in the same manner as the irritation or excite-
ment of the sensitive nerves of the sexual or-
gans and of erectile tissues affects the blood-
vessels of these parts. Serous effusion, dMhoMgh.
occasionally a consequence of irritation, is much
less frequently so than either inflammation or
hasmorrhage, and is met with, as a result of
this state, chiefly in leucophlegmatic or lym-
phatic temperaments, or in persons whose as-
similating and excreting functions are impaired
or interrupted.

27. C. The relations of irritation to the production
of morbid nutrition and secretion, although con-
tended for by Broussai.s, and most of the pa-
thologists of his school, are not so manifest
nor so uniform, or even general as they con-
tend. Viewing irritation as simple exaltation
of the organic nervous influence of the affected
tissue, increased nutrition and secretion might
be supposed to be legitimate consequences of
it ; and as irritation is not merely a simple,
but also a morbid exaltation of this influence,
so these consequences might be also inferred
to be morbid. These inferences are doubtless
correct as regards many cases of morbidly in-
creased nutrition and secretion, especially
when the irritation is exerted chiefly upon
muscular or contractile parts, and on secreting
organs and surfaces. Irritation affecting the
nerves of a hollow muscle will, if protracted,

IRRITATION — Pathological Relatio.vs of.

703

ultimately cause hypertrophy of this muscle ;
and a similar change in the state of the nerves
of the liver, or of the digestive mucous sur-
face, will both increase and otherwise change
the secretions of these parts. Morbid nutrition
and secretion, however, although very fre-
quently proceeding from irritation, do not al-
ways thus arise ; for either or both these more
palpable changes cannot, in many instances,
be traced to any obvious grade or form of irri-
tation, so far as irritation can be viewed as ex-
allation of the organic nervous power : they
must, therefore, be considered, as regards these
instances especially, as consequences of a fer-
version of this power, as I have endeavoured
to show in the article Disease. (See ^ 87,
et seq.)

28. D. That irritation should affect the state of
the blood, particularly when prolonged or ex-

■>;3sive in any important organ or tissue, may
readily be admitted. The usual effects of irrita-
tion upon the vascular system, especially in pro-
ducing a febrile state, and in thereby impeding
the functions of digestion, assimilation, and ex-
cretion, must necessarily, more or less, change
the blood from its healthy constitution. Even
in cases where local irritation does not pro-
duce marked febrile excitement, or merely a
remittent or intermittent form of it, the quan-
tity, as well as the healthy condition of the
blood, may be affected nevertheless. When
irritation of a particular tissue or viscus takes
place in plethoric persons, febrile excitement
or reaction may be very fully manifested, and
a consequent change in its constitution may
take place with a rapidity co-ordinate with the
grade of excitement ; but, when the blood is
deficient in quantity, or in the proportion of
hsematosine, the febrile excitement may be of
either a low, remittent, or obscure form, or be
identical with hectic, and the blood may expe-
rience still farther changes in its quantity and
constitution. But, in all cases, much of the
effect produced by irritation on the blood will
depend upon the temperament and circumstan-
ces of the individual, as will be shown here-
after.

29. While, however, this condition thus af-
fects the blood, the states of the blood, in their
turn, exert an equally marked effect upon the
local consequences or products of morbid se-
cretion and nutrition depending as much upon
the conditions of this fluid as upon the irrita-
tion which, existing in a particular viscus, has
determined these changes to take place in it.
Indeed, the materials furnished by the blood
often constitute and characterize these chan-
ges, the local irritation causing either a dis-
charge of a portion of these materials in the
secretions of the part, or their deposition in its
structure, thereby giving rise to various organ-
ic lesions, more fully described in the article
Disease {() 93, et seq), and in the various arti-
cles more particularly devoted to each of these
lesions.

30. iv. Of the Propagation, Reflection,
Reaction, and other Consechtive and Sym-
pathetic Phenomena of Irritation. — Irrita-
tion may act in various modes, or may have its
effects limited or extended, in various grades,
in different persons, in diversified circumstan-
ces, and according to the kind, nature, or degree
of the irritating cause. It may thus be, 1st. Sim-

ple or direct, its effects being either local, ex-
tended, or propagated ; 2d. Reflected, or con-
veyed to some portion of the nervous centre or
axis, and thence reflected upon distant parts ;
and, 3d. Consecutive, sympathetic, or reactive,
and constitutional. As to each of these modes,
it requires a more particular consideration.

31. A. Simple and direct irritation is (a) at
first local ; and, in this state, it may continue
for some considerable time, or for a period so
short as hardly to admit of appreciation ; and
(i) it may extend or propagate itself, or its effects,
to more distant parts. The extension of the
morbid action, condition, or impression, of which
irritation consists, varies, 1st. With the nature
and intensity of the cause producing it ; 2d.
With the state of organic nervous or vital pow-
er ; and, 3d. With the conditions of the blood
and of the excreting or depurating functions.
When the cause is intense in its operation, and
at the same time contaminating, vitally de-
pressing, or poisonous, relatively to the state
of vital power or resistance, the irritation or
local effect produced by such cause is rapidly
extended, by means chiefly of the organic ner-
vous and vascular systems, to adjoining parts,
and even to the whole frame. On the other
hand, when the cause is merely mechanical, or
simply irritating, without being depressing or
contaminating, the constitutional energies con-
tinuing unimpaired and the blood uncontami-
nated, the irritation may be long in producing
more extended effects, or materially injuring
the frame. It is chiefly when the organic ner-
vous influence is weak, the secreting and ex-
creting functions are already impaired, and the
blood more or less .morbid, that irritation is
rapidly followed by severe local and constitu-
tional disorder. When the blood is supera-
bundant as to quantity, and especially as to the
quantity of hsematosine, or fibrin and albumen,
relatively to that of serum ; when the blood is
thus rich and inflammatory, and the tempera-
ment and diathesis are sanguine and phlogistic,
then the irritation, unless its cause be poison-
ous or contaminating as well as irritating, soon
assumes an inflammatory character, and is
quickly followed by all the local and constitu-
tional effects of inflammation.

32. When the irritation is slight or mod-
erate, the blood being neither superabundant
nor rich, or even somewhat deficient or thin,
and the temperament being phlegmatic or lym-
phatic, then it may not produce great change,
either locally or constitutionally, until it has
continued long, or affected the secretions of
the part ; but when these stales of the vascu-
lar system are coexistent with the nervous or
irritable temperament, the local, and especially
the remote and constitutional effects of irrita-
tion will be quickly and severely manifested,
particularly on the nervous system, and on
muscular or contractile parts. Illustrations of
these facts occur frequently in practice, and
are met with in many of the affections char-
acterized by extreme pain and spasm. Irrita-
tion is influenced, as to grade and consequen-
ces, not only by the temperament, diathesis,
and states of the blood and of the secretions,
as just stated, but also by organic nervous
power, and by whatever tends to depress or
vitiate this power, or to contaminate the blood.

33. In depressed states of vital power, irri-

704

IRRITATION — Pathological Relations of.

tation more rapidly develops its effects, other
circumstances being equal, than when this
power is unimpaired, the resistance exerted by
the constitution to the morbid impression or
irritation being weaker, and consequently the
less capable of overcoming this primary affec-
tion, which increases and extends itself with a
rapidity co-ordinate with the vital or the or-
ganic nervous depression or exhaustion. Mor-
bid conditions of the blood, arising from the
passage of contaminating matters into it, or
from the accumulation of effcete materials in
it, owing to deficient or interrupted action of
eliminating organs, exert an equal, if not a still
more remarkable influence, in favouring and in
accelerating the extension and consequences
of local irritations. Punctures, external abra-
sions, local injuries, the acrid, contaminating,
and animal poisons, and numerous other caus-
es acting locally, or even on the minutest point
of the organism, produce effects of the most
severe and deleterious character in these cir-
cumstances of organic nervous power, and o-f
the circulating fluids ; and, although these caus-
es are often deleterious in the most healthy
conditions of the frame, yet are they very much
more so in the circumstances just now stated,
occasioning the worst forms of erysipelas, dif-
fusive inflammations of the integuments and
subjacent cellular tissue, the most violent con-
stitutional disturbance, contamination of the
blood and soft solids of the body, with effusion
into shut cavities and other lesions, and, ulti-
mately, death.

34. B. Reflected irritation may be of three
kinds ; namely, (a) The irritation may occur in
a surface or part of a viscus supplied either
chiefly or solely with organic or ganglial nerves,
and be transmitted to the ganglion by the ner-
vous fibres first affected, and thence reflected
upon these fibres themselves, or upon others
supplying different structures, or communica-
ting with other parts of this system, or with
the cerebro-spinal axis. — (b) The irritation may
commence as in the preceding variety, and
extend to either the roots of the spinal nerves,
or the chord itself, and thence be reflected, in
the form of pain or spasm, to superficial parts,
or to the extremities. — (c) The irritation may
commence in, or affect the nerves of sensation
in these last situations, be transmitted to the
spinal chord, or to the roots or ganglia of the
spinal nerves, and be reflected thence by sen-
sitive and motory nerves, occasioning altered
sensation, morbid sensibility, or convulsive or
irregular movements. These several modes
of reflected irritation occur most frequently in
nervous and irritable temperaments, and in
persons neither plethoric nor robust.

35. a. The first of these often attends visceral
disease, both functional and organic, hysteria.
the several forms of colic, constipation, gastro-
intestinal disorders, visceral neuralgia, or pain-
ful affections of the abdominal organs, and dis-
eases of the sexual and urinary organs, but
generally in irregularly or imperfectly mani-
fested states. Irritation of the nerves of the
uterus or ovaria, or exaltation of their sensi-
bility, may be extended to the ganglia, from
which these nerves depart, and be reflected
thence, not only upon these organs themselves,
but also upon the intestinal canal, giving rise
either to irregular movements of its muscular

coats and to borborygmi, or to altered sensibili-
ty, or to abdominal pains, such as I have de-
scribed in the article Hysteria, or to both
spasm and pain, as in hysterical colic. The
irritation of calculi in the pelvis of the kidney
may be extended to the renal ganglion, and
be thence reflected upon the digestive tube in
the form either of colic, or of nausea or vom-
iting. The irritation of calculi in the bile-ducts
may, in a similar manner, be reflected upon
the duodenum, stomach, or other abdominal
organs.

36. b. The second variety of reflected irrita-
tion, or that extending to the cerebro-spinal
nerves, and from thence expressed upon super-
ficial or distant parts, may exist either alone or
in conjunction with the foregoing variety, as in
the several forms of hysteria, especially the
more irregular forms of it, in chorea, in ver-
minous complaints, in symptomatic epilepsy,
cholera, &c. In these affections, as shown in
the articles devoted to them, irritation affects
a certain portion of the organic nervous circle,
and extends to corresponding ganglia, and is
thence reflected upon the fibrils of gray nerves
supplying other viscera, or upon those commu-
nicating with the roots of the cerebro-spinal
nerves, occasioning either altered sensibility or
extreme pain in the extremities of the nerves
of sensation, or spasmodic or uncontrolled
movements of the voluntary r*uscles, through
the medium of the nerves of motion. The con-
vulsive affections of infants and children are
frequently thus produced without any disease
of the brain, although the circulation in this
quarter generally is affected in the course of
the convulsion, owing to the disorder of the re-
spiratory processes attending it, and to the im-
peded passage of blood through the lungs and
heart. The irritation of worms in the intesti-
nal mucous surface gives rise not only to vari-
ous painful and spasmodic states of the canal,
and to palpitations of the heart or of the ab-
dominal aorta, but also to convulsions and spasm
of voluntary muscles in the manner just ex-
plained, and as I have stated in the article Cho-
rea (ij 16, 17). In 1820 I treated at a dispensa-
ry a case characterized by constant clonic spasm
or convulsive movements of the abdominal mus-
cles. The cause was instantly recognised ;
spirits of turpentine was prescribed, and im-
mense accumulations of faecal matters and
many hundreds of lumbrici were evacuated ;
and then the convulsions of the voluntary mus-
cles ceased. This case was published (see
Land. Med. Repos., vol. xvii., p. 242) soon after
its occurrence, and was explained as above.
Other illustrations of this form of reflected ir-
ritation might here be adduced, but they are
unnecessary-, others will be noticed hereafter.

37. c. In the third variety, or when the irrita-
tion implicates, or is seated in, the cerebro-
spinal or sensitive nerves, and is transmitted
either to the plexuses of nerves, or to their
roots, or through these to the spinal chord, and
even to the brain itself, and is reflected thence
so as to manifest its effects in the form either
of spasm or convulsion, or of pain or altered
sensibility of some superficial or distant part
or limb, then consciousness is frequently af-
fected, in some way or other, in the course of
the process ; and, consequently, the functions
of the brain are co-ordinately implicated. Still,

IRRITATION — Pathological Relations op.

705

the brain may be no fartbcr affected than in
being cognizant of either the primary affection,
or of its sympathetic effects, or of both. In
this case, only one of the functions of tiie brain
is acted upon, and all tlie otbcr functions are
unimpaired and unaffected. Ijut in other in-
stances, the irritation, owing either to its inten-
sity and extension to tlie cercbro-spinal axis
itself, and more especially to the brain, or to
the latter organ being implicated in the course
which it takes in developing its effects, may so
aflfect the brain as completely to overpower its
functions ; yet this result rarely takes place
without being attended by convulsions.

38. On a careful examination of disorders
characterized by convulsions, spasms, or irreg-
ular muscular actions, we shall find that they
may be divided into, 1st. Those which are at-
tended by consciousness ; and, 2d. Those in
which consciousness is suspended. The one,
however, may pass into the other, but in com-
paratively rare instances. In the former of
these, the brain retains the power of sensation,
and is not incapable of exerting its functions
during the paroxysm ; in the latter, conscious
sensation is for a time altogether overwhelmed,
and is restored, more or less rapidly, after the
attack has ceased. It may reasonably be in-
ferred that, in the one, the primary irritation is
propagated to the roots of the spinal nerves
only, or to the spinal chord, and reflected thence,
by the motor nerves, upon the voluntary mus-
cles, the brain being still capable of discharging
all Its functions, excepting that of controlling
the muscular movements ; in the other, the ir-
ritation extends to the brain, or affects it or its
circulation, in such a manner as to suspend or
to extinguish consciousness and all its modifi-
cations for a time. In many, if not all the lat-
ter class of cases, the medulla oblongata seems
to be the part more immediately implicated ;
as soon as the affection extends to it, con-
sciousness and the other subordinate manifest-
ations of mind being suspended for a time. (See
article Convulsions, () 42, ei scq.)

39. b. Seeerc or 7icttralffic pains are often caus-
ed by irritation, the source of which may be in
the trunk of the nerve whose terminations are
thus afl'ected, or in the spinal chord, or in vis-
ceral or ganglial nerves passing to the roots of
the spinal nerves, or to the spinal chord itself
In this latter case, the primary irritation mani-
fests its efl'ects in distant parts by a reflex sym-
pathy, as already described, and as long since
insisted upon in the works already referred to. '
In all instances of pain from irritation, whether !
the irritating cause be seated in the nerve itself, '.
or in the chord, or in other or distant nerves,
the effect being reflected by means of cither
the chord or of ganglia, it is expressed chiefly
in the ultimate ramifications or smaller branch-
es of nerves. When the pain is seated in the
trunk of a nerve, it will generally be found that
the sheath or neurilema of such nerve is infla-
med, either in the seat of pain or near it. In
a case recorded by Dr. Denmakk, where ex-
treme pain was felt in the points of the fingers
and thumb, the limb was amputated, and a small
portion of a ball, which had been detached from
it when it struck against the bone, was found
imbedded in the fibres of the median nerve.
In several cases which have occurred in my
practice, as well as in others recorded bv au-

" 89

thors, irritation and chronic inflammation of
the spinal chord or of its membranes have been
attended by pain in nerves, chiefly of their ex-
tremities, given ofl^from the parts of the chord
chiefly afl^ected. Numerous illustrations of this
are given in the article Neuralgic Akfections.
In nearly all cases where the pain is caused by
irritation merely, it is intermittent or periodic,
or returns only after distant intervals. But
when it is produced by inflammation, or by ir-
ritation of an intense and permanent kind, it is
either continued or remittent only. When it
proceeds from the former cause, it is sudden in
its accession, intense in grade, often brief in du-
ration, and it generally ceases suddenly. When
it arises from the latter cause, it is more grad-
ual in its increase and subsidence, and more
permanent than in other circumstances.

40. The cases of pain from irritation, ex-
pressed in distant parts by reflected sympathy,
furnish some very singular phenomena, which
fall more particularly under consideration in
other articles. These are characterized chiefly
by their seat, intermittency or remittency, and
by the non-febrile and non-plethoric states of
the vascular system, in the very great majority
of instances. Thus, irritation of the stomach
or bowels, by accumulated matters, or by acid-
ity, or by flatulence, or by morbid secretions,
often causes severe pain in distant and super-
ficial parts, or even in less remote organs. A
gentleman was seized suddenly with a violent
pain in the heart. I was called to him, and,
while I wrote a prescription, I directed him to
swallow two or three small pods of Cayenne
pepper, which were at hand in a bottle of pick-
les. He instantly afterward eructated much fla-
tus, and the pain as instantly ceased. Pains
of short duration, but of great severity, are oft-
en experienced during disorders of the digest-
ive organs, in various parts of the body far re-
moved from the seat of irritation. Thus, pain
at the vertex, or in the temple, or in a limb, or
in other parts, is sometimes felt ; but it in-
stantly ceases upon the escape of accumulated
flatus, or upon the neutralization of acid in the
prima via, or after the operation of an emetic
or of a brisk cathartic. (See article Neuralgic
Affections.)

41. C. Reactive, Consecutive, and Sympathetic
Irritation. — In certain circumstances of the
ceconomy, especially those which will be noticed
hereafter, irritation gives rise to general vas-
cular reaction, or to various consecutive anu
sympathetic effects, having a more or less ob-
vious relation to the state and grade of the pri-
mary affection. In most instances, the first ef-
fect of irritation is displayed in the vessels of
the part, in one or other oi' the modes described
above — in either inflammatory action or haem-
orrhage ; but in some cases, tlie irritating cause,
owing to its nature, or to the part irritated, or
to the constitution and diathesis of the individ-
ual, gives rise to very severe febrile commo-
tion, or to various consecutive phenomena of
either a painful, or a spasmodic or convulsive
kind, without the local vascular disturbance
being remarkable ; and these effects may be
general as respects the ceconomy, or more or
less limited in extent, or may change their seats
and character. Chemical irritants, and vari-
ous vegetable and animal poisons, produce these
efTects, which usually present a very marked

706

IRRITATION — Pathological Relations oj".

speciality, their characters varying with the
cause which produced them, and with the cir-
cumstances in which they are developed. Thus,
the irritation of the digestive mucous surface,
or of some part of it, hy worms, by acidity, by
flatulence, hy noxious ingesta, or hy accumula-
ted soides, frequently is followed by spasmodic
movements of the voluntary muscles, by pain-
ful aflections of the joints, by neuralgic or rheu-
matic pains, by gout, and by various visceral
affections of a painful or of a functional kind.

42. The presence, also, of morbid elements
in the blood, or the accumulation of those ma-
terials in it which require to be eliminated, will
not only occasion irritation of some portion of
the organic nervous system, but more especial-
ly of that portion which is supplied to or actu-
ates the organs destined to the elimination of
these materials, but will, at the same time, fa-
vour the rapid development of the reactive and
sympathetic effects of the more local affection.
Gout, erysipelas, and several other diseases,
illustrate this principle ; indeed, most of the
disorders which are seated principally in the
excreting organs furnish proofs of the truth of
this view. From the foregoing, it may be safe-
ly stated that the sympathetic effects of local
irritation are to be traced by means, 1st. of the
nervous system of organic and animal life ; 2d,
of the vascular system and blood ; and, 3d, of
the excreting viscera as influenced by the or-
ganic, nervous, and vascular systems. But the
consideration of these, if farther pushed, leads
to the following part of the subject, which is
very intimately connected with the foregoing
general views.

43. V. Constitutional Effects of Irrita-
tion. — The principal and most serious effects
of irritation are ascribable, 1st, to the nature
of the irritating cause ; 2d, to the state of or-
ganic, nervous, or vital power, especially as
manifested by the irritability of contractile
parts ; 3d, to the state of the circulating fluids,
particularly as respects the accumulation of ex-
crementitial or noxious materials in the blood;
and, 4th, to the functions of eliminating and
depurating organs. — a. Of the influence of the
causes in determining the evolution, as well as
the kind of constitutional commotion produced
by irritation, sufficient notice will be taken here-
after ; and I have already shown (<^ 31) that the
effects of irritation are. caeteris paribus, more
extensively, more rapidly, and more severely
propagated throughout the frame, the more the
organic nervous or vital power is depressed at
the time when the irritating cause is in opera-
tion.

44. h. When the circulating fluids are loaded
with noxious elements or materials, in conse-
quence either of interrupted excretion or of the
absorption of injurious matters, not only is the
vascular system the more readily excited there-
by to increased action, but the vital power is
also greatly impaired at the same time ; and
hence, although vascular action is augmented,
power is diminished, and the sooner altogether
exhausted. The impeded or interrupted action
of depurating or excreting organs, in first caus-
ing a morbid state of the blood, exerts, accord-
ing to the extent of this primary effect, a simi-
lar influence in developing, accelerating, and
aggravating the constitutional operation of lo-
cal irritants ; and hence the necessity of bring-

ing our means of cure to act upon these organs
in all cases of local as well as of constitutional
irritation. The influence apparently arising, in
connexion with irritation, from a superabun-
dance or deficiency of blood, and from a too
rich or a too poor or watery state of this fluid,
has been already noticed, particularly with ref-
erence to the supervention of inflammations,
haemorrhages, and various spasmodic and ner-
vous affections ; but these conditions of the
vascular system seldom give rise to so rapidly
developed, so severe, or so dangerous commo-
tions of the whole ceconomy, as when the blood
is loaded with excrementitious materials, and
when important emunctories are interrupted or
impeded in their functions. It may be, there-
fore, inferred, as a pathological axiom, that,
other circumstances being the same, the con-
stitutional effects of local irritants will vary
with, and be proportionate to, especially in the
rapidity of their development and in the sever-
ity and acuteness of their characters, the grades
of vital power and of vascular purity, and the
states of the several emunctories. In propor-
tion as power is reduced, and the blood is im-
pure or changed from its healthy state, so the
brain becomes oppressed, the soft scdids con-
taminated, the vital cohesion of the tissues
weakened, and the depurating organs impeded ;
effusions of serum, sero-sanguineous exuda-
tions, hjemorrhages, and various structural
changes ultimately supervening, with more or
less rapidity. Erysipelas, local irritants giving
rise to diffusive inflammation of the cellular
tissue, wounds or injuries, and punctures fol-
lowed by severe disturbance, and many acute
affections consequent upon irritating and mor-
bid poisons, furnish sufficient illustration of
these inferences.

45. vi. Of the Continuity, Periodicity,
Duration, and Terminations of the Effects
of Irritation. — A. The effects of irritation are
seldom covtinued, or of equal severity through-
out, unless they be aggravated by morbid con-
ditions of the blood, or by impeded action of the
emunctories. In such cases they may be pro-
gressively acute or severe, until they terminate
fatally, without any appreciable intermission or
even remission. The blood may also be more
or less contaminated, particularly by the absorp-
tion into it of morbid secretions, and yet the
effects will still assume a periodic or remittent
form, as in cases of hectic fever; but very gen-
erally the constitutional effects of irritation are
continued when the blood is much contamina-
ted either by absorbed matters or by unelimi-
nated elements, as shown by most of the forms
of erysipelas, by the consequences of punctured,
poisoned, or contaminated wounds, and by nu-
merous irritating causes acting locally in these
states of the vascular system.

46. B. The effects of irritation, whether they
be spasmodic, or neuralgic, or painful, or con-
stitutional, are most commonly periodic, or re-
cur after intervals, or become aggravated by
paroxysms, if they do not cease altogether for
a time. The recurrence or aggravation of these
effects generally observes no regular periods,
unless intermittent and remittent fevers be con-
sidered as constitutional manifestations of irri-
tation of the organic or ganglial nervous sys-
tem, in which point of view, indeed, I have
chiefly contemplated them in their more sim-

IRRITATION— In Relatio!* to its Causes.

707

pie slates. As long as irritation extends no
farther than the nervous systems, and while the
excreting organs and vascular system and blood
are not greatly disturbed, it generally thus man-
ifests itself more remarkably at one time than
another. In many ca.ses, the irritation seems
to proceed or to exist in a latent form, or the
irritating cause seems to have ceased to pro-
duce any results after its more immediate ac-
tion, until some adventitious circumstance oc-
curs, or some change takes place in the states
of organic nervous or vital power, or of the ex
creting viscera, favourable to the development
of its effects ; and these effects may either in-
crease progressively or recur more frequently,
or they may soon cease altogether, owing either
to c.vhaustion or to the subsidence of the pri-
mary morbid condition.

47. In cases of neuralgic pains, the effects
of irritation manifested in distant parts, as
above shown, by either a direct or rrftcx sympa-
thij, as well as in cases of spasmodic or con-
vulsive movements similarly produced, we ob-
serve certain phenomena or circumstances of
an important and practical kind : 1st. That
these attacks are immediate, severe, and con-
tinued, in proportion to the intensity of the irri-
tating cause relatively to the grade of constitu-
tional or vital power ; 2d. That they are favour-
ed and aggravated by whatever lowers the or-
ganic nervous energy and vital resistance, the
intervals between them becoming shorter or
less marked, and the seizures longer or more
frequent the more this power is reduced ; 3d.
That these attacks are similarly affected by im-
paired excretion and evacuation, and by impure
or morbid states of the blood ; and, 4th. That
they are influenced in the same way by mental
depression, and by directing the mind either
frequently or for a lengthened period to them.

48. C. As to the cause of the periodicity, or
of the recurrence of the effects of irritation, no
farther or more satisfactory information can be
given than by assigning this character to a law
of the animal oeconomy, which is observed as
long as these effects do not extend much be-
yond the nervous systems, or implicate the
more important emunctories and the blood and
vascular system. If we attempt to proceed
farther in our research, we can infer only that
all causes exciting or irritating the source of
irritability and the sentient system, produce
their effects on sensibility and on muscular
movements in a more or less remittent or par-
oxysmal manner, the intermissions being com-
plete and prolonged in proportion to the slight-
ness of the cause relatively to the susceptibility
of the nervous system and state of vital power.
Even the most violent of painful and spasmodic
diseases, as neuralgia and tetanus, are charac-
terized by exacerbations during the attack ; and
these exacerbations exhaust, for a time, the
sensibility and irritability, which, however, are
quickly restored under the influence of the
causes which continue to excite them ; or, in
other words, irritation being once excited in
any part of the source of irritability or of the
sentient system, explodes itself in fits or shocks
on tliose parts most immediately connected
anatomically and physiologically with these
sources ; and when the cause of irritation con-
tinues in action, or when the irritation is in-
tense, although the cause which excited it may

have been removed, the effects may continue
until the vital energies are exhausted, or may
even increase with the vital exhaustion, until
life is extinguished, unless some powerful agent
be employed capable of fortifying the nervous
power and vital resistance, and thereby ena-
bling them to overcome the morbid impression
which has been produced, or to resist the oper-
ation of the causes which are present, until the
parts become accustomed to their influence.

49. D. The duration of irritation depends
chiefly upon the same circumstances as have
just been shown to influence the character or
type of its effects (ij 45) : these circumstances,
however, tend more especially to render the
disease more acute, and of shorter duration
than it would otherwise prove. In general,
irritation is prolonged in proportion to its slight-
ness relatively to the degree of vital or consti-
tutional power ; and it may continue or recur
for an indefinite period, as long as vascular ac-
tion and the states of the blood, and of the
emunctories. are not very materially affected
by it. As these become deranged or remarka-
bly diseased, so the duration of the resulting
malady is equally short ; and this is especially
the case when muscular contractility is either
inordinately excited or very greatly impaired.
Tetanus, rabies, poisoned wounds, &c., are il-
lustrations of the short duration of the effects
of irritation when its action is energetic, and
when its consequences are extensive in respect
of the nervous, vascular, and muscular systems.

50. E. The terminations of irritation have
been partly noticed {ij 23) when remarking the
effects or consequences of it upon the vascular
and muscular systems, and upon the secretions
and nutrition. The effects of it on these parts
of the oeconomy are often intermediate between
an advanced stage of its development and its
termination ; but still, irritation may arise and
subside, or terminate in healtli, without any of
its more palpable consequences or strictly struc-
tural lesions having been produced, sensibility
and contractility having been only temporarily
disturbed. It may terminate in death in a very
short time, owing to the intensity of its action,
or to its violence, as expressed chiefly on the
sensibility or on the muscular and vascular sys-
tems, and previously to any very marked effect
upon the organization, altliough generally the
secreting and excreting functions, and the chan-
ges in the blood requisite to the continuance of
life, are either impaired or arrested before death
is occasioned. Irritation may also produce va-
rious lesions, already alluded to {i) 27-29), these
lesions either superseding, extinguishing, or
merely masking the original mischief; or then
greatly increasing both it and its eflects. Most
frequently when irritation terminates fatally,
this result is owing more to the changes, often
numerous and consecutive, produced by it,
than to the violence of this state, as expressed
merely on the sensibility and irritability of the
frame, although the changes in these latter
properties may either altogether, or only partly,
produce this last result.

51. III. Of the Influence of the Agents
OR Causes on the States and Chakacters of
Irritation. — i. 0/ predisposition to irritation. —
An increased susceptibility of irritation may
arise from a great variety of circumstances.
The influence, however, of several of these is

708

IRRITATION— In Relation to its Causes.

not satisfactorily established, or, rather, hardly
admits of proof. It appears very probable that
the usual causes of irritation act more readily,
and with greater intensity, (a) On the irrita-
ble, nervous, and sanguineous, than on the
phlegmatic, bilious, melancholic, and lymphatic
temperaments ; {b) On the scrofulous and gouty
diathesis, and the delicate and enfeebled consti-
tution, than on the sound and robust ; (c) On
the young than on the old, and more particular-
ly on infants and children ; (rf) On the female
than on the male sex. Besides these causes
of predisposition, others may be enumerated,
as hereditary or original constitution ; unwhole-
some diet and insufficient food ; modes of liv-
ing calculated to weaken and to impede the di-
gestive, assimilative, and depurating functions ;
confinement in-doors, insufficient exercise, sed-
entary occupations, and deficient ventilation.
All the depressing passions and emotions ; soli-
tary confinement, suppressed feelings, and pri-
vation of light, sunshine, and fresh air ; debility
and pre-existing disorder, more particularly tor-
por of the bowels, and of the excreting organs
generally; the superabundance of excrementi-
tial matters in the blood, or the absorption into it
of morbid secretions; and either too great ful-
ness or extreme deficiency of the blood, or vital
depression and vascular plethora, or inanition,
or contamination, either individually or vari-
ously conjoined, favour the operation of the
more immediate causes or agents of irritation
on the frame.

52. ii. The Exciting Causes. — The operation
and nature of these, conjointly with the state
of predisposition, influence and determine the
form and character of irritation. — A. The nature
and amount of external injury, especially in con-
nexion with the shock sustained by the fficono-
my on the infliction of it, often produce irrita-
tion of a serious kind, both locally and consti-
tutionally ; and the particular nature and rela-
tions of this effect arc often misunderstood and
unsatisfactorily treated. Among these injuries,
surgical operations may be classed. The na-
ture and character of the irritation also vary
much with the nature of the tissue or part pri-
marily affected or injured. Thus, a puncture or
laceration of a tendon, or of an aponeurotic ex-
pansion, will more readily induce tonic spasm
or tetanus than neuralgia ; and the spasm will
more readily be produced in a person predispo-
sed by a combination of circumstances ; by an
irritable or nervous temperament ; by depres-
sion of organic nervous and vital power; by
accumulations of morbid secretions in the bow-
els ; and by the depressing passions, than in a
healthy individual. An irritating body, lodged
either between the fibrils of a nerve, or u[)on
its sheath, may so alter the sensibility of its
sensitive fibrils as to occasion acute pain in
their ramifications and terminations, even with-
out affecting the motor nerves, or affecting
them only slightly and occasionally. In many
external injuries the cercbro-spinal nerves may
entirely escape, and yet the extent of mischief
and the shock to the sy.stem may be great. In
such cases, the other structures may be serious-
ly injured, and especially the organic nerves :
these latter affect the circulation in the vessels
of the injured part, and consecutively the vas-
cular system generally ; and thus extreme suf-
fering, shock to the constitution, and vascular

reaction — unless the vital powers are entirely
overwhelmed by the amount of injury and the
attendant shock, so as to prevent reaction —
are successively produced. In perusing the
numerous instances of surgical operations de-
tailed in various works, the physiological pa-
thologist will readily recognise, in many of the
phenomena attending these cases, the effects
of irritation caused by the operation. A man
is operated upon for axillary or subclavian an-
eurism, and the ligature placed upon the sub-
clavian artery necessarily produces not only a
shock to the constitution, but also irritation as
the shock subsides, owing chiefly to the cir-
cumstance of the organic nerves surrounding
the vessel in a closely reticulated plexus being
enclosed, strangulated, or irritated by the liga-
ture. Hence the oppressed breathing, general
coldness, and sinking of the vital powers, fol-
lowed by febril commotion and various painful
spasmodic and sympathetic affections, accord-
ing to the peculiar circumstances of the case,
so frequently consequent upon such operations.

53. B. Numerous mechanical and chemical ir-
ritants produce not only great local, but also,
consecutively, much constitutional irritation.
These, however, are generally no farther inju-
rious than by disordering or inflaming the parts
to which they are applied, unless they are so
energetic as to disorganize the structure, as
concentrated acids, alkalies, &c. Much of the
local and constitutional irritation produced by
these, unless they are thus energetic, or are
brought in contact with an extensive surface,
is owing to the states of the system, and espe-
cially of the organic functions — deficient vital
power, impure states of the circulating fluids,
and impaired secretion and excretion, particu-
larly favouring the effects of these agents.

54. C. Many substances combine, with much
local irritation, a narcotic or alterative effect
upon the nervous and vital properties. — a.
These acro-narcotics exert a decidedly poison-
ous effect, characterized not merely by local
and general irritation, but also by a specific
condition of the vital functions. T()ere are
both a local irritation or inflammation produced
by them, and a change in the states of sensibil-
ity, of irritability, and of secretion and excre-
tion, having a special reference to the agent or
cause. Most of these substances are derived
from the mineral and vegetable kingdoms, and
constitute, owing to their peculiar modes of
action, the principal part of our means of curing
disease, when judiciously employed.

55. h. Numerous animal substaiiccs occasion
either local or general irritation, or both, or
combine with this a contaminating' or poison-
ous effect. In some instances, their operation
locally and constitutionally, is chiefly of a sep-
tic nature, dissolving the vital cohesion of the
tissues, and contaminating the circulating flu-
ids ; in others, their action is more strictly irri-
tant, in respect either of the organic or of the
cerebro-spinal nervous system, or of both. i)ut
generally of the former especially ; and again,
in others their influence is both septic, as re-
gards the tissues and fluids, and depressing, as
respects the vital endowment. Thus, putrid
animal matter acts principally in the first of
these modes, yet partly, also, as a local, and,
through the medium of the blood and vascular
system, as a constitutional irritant. The virus

IRRITATION — In Relation to its Causes.

709

of rabies affects chiefly the nervous systems,
irritating, first, the part inoculated with it, and,
consecutively, the organic nervous functions,
and, lastly, the cerebro-spinal actions. The
venom of serpents and insects both dissolves
the vital cohesion of the tissues to which it is
applied, contaminates them and the fluids, and
remarkably depresses the vital manifestations.

56. c. Acid or excrement ttious mailers passed
into, or accumulated in the blood, are more fre-
quent causes of constitutional commotion or
irritative feter than is generally supposed. V^a-
rious secretions and excretions, when accumu-
lated or retained, are partially absorbed, and
render the blood impure (see art. Absokption,
^ 15) ; others, when interrupted or suppressed,
are followed by a redundancy in the blood of
the materials forming them, which materials
are the causes of irritative fever, of excessive
action and greatly depressed vital power. Uri-
nous fever, or the constitutional commotion oc-
casioned by suppressed or interrupted secretion
and excretion of unne, is one of the forms of
irritative fever caused by the accumulation of
excrementitious or morbid matters in the blood.

57. d. The passage, also, of morbid secretions
into the circulation is often productive of the
worst forms of constitutional irritation. If
these substances pass gradually, so that their
elimination from the blood is as rapid as their
introduction into it, the consequent irritative
fever is comparatively slight, and generally as-
sumes a hectic or remittent form ; but when it
passes more abundantly and rapidly, as in cases
of phlebitis and of diffusive inflammation of the
cellular tissue, the constitutional disturbance
is very much more serious and acute, and very
closely resembles the worst forms of putro-
adynamic fever. In lying-in hospitals, where
the vital powers are reduced, first, by the shock
xittending parturition, and, secondly, by the im-
pure air of the ward, and when, in conse-
quence of these circumstances, the uterus con-
tracts imperfectly, or allows a considerable
quantity of the bloody sanies escaping from the
vessels on its inner surface to accumulate in
it, a portion of this sanies is absorbed or im-
bibed by the veins into the circulation, and irri-
tative fever or constitutional irritation of the
worst and most rapidly fatal form is soon de-
veloped. In many of these cases, as I have
proved by repeated observation and post-mor-
tem research, the imbibition or absorption of
the matter from the cavity of the uterus, and
the consequent contamination of the blood,
takes place without producing uterine phlebitis,
or, at least, without occasioning that form of
phlebitis which is attended by the production
of coagulable lymph in the veins (see Veins,
Inflam. of) ; while in others the uterine and
spermatic veins are inflamed, either primarily
or coetaneously, owing to the irritation of the
matters retained in the uterus at the mouths
of the veins or sinuses left exposed by the sep-
aration of the placenta, or as they pass along
the veins, during the process of imbibition.
The most adynamic and rapidly fatal cases are
of the former description, the more inflamma-
tory and prolonged instances are of the latter ;
but this important subject is fully discussed in
the article on Puerperal Diseases and Fevers,
where the results of long and extensive expe-
tience are given. The rapid absorption of fluid

effused into the cellular tissue, as in phle<^masia
dolcns, (edematous erysipelas, diffusive inflamma-
tion of t/ic cellular tissue, and in cases of non-
encysted abscesses, is generally followed by con-
stitutional irritation of a most remarkable kind,
vascular action being excessive, but devoid of
power or tone, and all the vital and nervous
functions being remarkably depressed. In a
case of phlegmasia dolens of both thighs, under
my care in 1832, the swellings very rapidly sub-
sided, but were soon followed by all the symp-
toms of adynamic or typhoid fever, requiring
the free use of restoratives and antiseptics,
which produced a most beneficial effect and
rapid recovery.

58. e. All the animal poisons, and all the ema-
nations produced from dead and living organized
bodies, seem to act first as local, and more or
less rapidly as constitutional irritants. The
most remarkable of these is the virus or fluid
sometimes inoculated when examining recent-
ly-dead bodies. This poison produces excess-
ive irritation of the nervous systems, locally
and constitutionally, with extreme prostration,
weakness, and rapidity of the heart's action,
&c., soon followed by fatal exhaustion. But,
while these animal or morbid poisons irritate
more or less the organic nervous and vascular
systems, they likewise depress their vital man-
ifestations and contaminate the blood and se-
cretions. They act as a kind of leaven which
infects the whole oeconomy, and imparts to it
the power of developing a poison, like itself in
all respects, capable of producing the same ef-
fects, and thereby perpetuating itself (See
arts. Infection; Poisons, Ani.mal, &,c.)

59. /. Numerous substances irritate the sys-
tem when received into the stomach or bowels,
or passed into the circulation, each producing
an effect having a strict reference to its nature
or peculiar properties, and to the quantity of it
taken or introduced into the blood. Indeed, the
operation of a large proportion of medicines
depends upon this specific influence, modified,
however, by a variety of circumstances, duly
considered and taken advantage of by the ob-
servant and experienced physician. In cases
of irritation from these causes, the local and
constitutional effects vary with the tissue or
viscus upon which they individually act, with
their absorption or non-absorption into the cir-
culation, with the quantity of the substance
employed, and with their specific influences on
the diflferent emunctories. Substances which
are absorbed, or which otherwise pass into the
blood, exert, according to their nature or pecu-
liar properties, more or less of irritation of the
vascular system, and of the organs by which
they are excreted from the blood, modifying, at
the same time, the functions of the mucous and
cutaneous surfaces, and the states of nervous
influence. Owing to these circumstances, these
agents produce more or less constitutional com-
motion, or irritative fever, unless their influ-
ence is slight or is limited to some excretory
organ or surface.

GO. g. The sensations, when acutely excited,
are often causes of irritation, more especially
of those parts of the cerebro-spinal nervous
system with which tliey are in the most inti-
mate correspondence. Thus, inordinate excite-
ment or irritation of the organs of sense is oft-
ten followed by inflammatory excitenaent of the

IRRITATION— Treatment of.

brain, or of its membranes ; and of the nerves
of sensation in the extremities, or in the gen-
eral surface, by convulsions. Morbid sensation
occasionally exerts a similar influence, or re-
acts upon and augments the primary irritation
producing it. Acutely excited sensation may
occasion, by either a direct or reflex sympathy,
morbid sensations in distant parts, or spasmodic
or convulsive movements, or, by exciting the
vascular system or impairing the excreting
functions, constitutional disturbance of a more
or less severe nature. Indeed, this cause, par-
ticularly in connexion with the excitement of
a pleasurable feeling, as in sexual irritation, is
a much more common source of the diseases
of irritation, or, at least, of those which are thus
characterized at their commencement, than is
generally supposed ; and it is almost equally
prevalent and mischievous in both sexes. Its
consequences are manifested both by direct and
reflex sympathy, giving rise to disordered func-
tion, morbid sensation, disordered or uncontrol-
lable muscular movements, and ultimately to
constitutional disease. If we trace the progress
of the mischief, we shall detect the effects, first,
in the weakness of the various digestive func-
tions, through the medium of the organic ner-
vous system ; next, in the cerebro-spinal ner-
vous system, as evinced by morbid sensibility
of the spinal nerves and weakness of the men-
tal faculties, or by afl^ections of the voluntary
and involuntary muscles, or by convulsions;
and, lastly, in the augmented disorder of all
these, in disease of the vascular system, in de-
ficiency and poverty of the blood, and in various
nervous, cachectic, and even structural chan-
ges, terminating in some instances in death.

61. h. Various moral emotions and intellectual
powers, when inordinately excited or exerted,
and especially the malevolent passions, anxiety,
and some of the depressing feelings, excite
more or less of irritation, disturb the circula-
tion in the brain, and disorder the actions of
the heart. In addition to their more strictly
local effects, particularly in respect of the ner-
vous system, they may also produce violent
constitutional commotion, and derange all the
secreting, assimilating, and excreting functions,
this latter effect increasing still farther the vas-
cular or febril disturbance. The mental emo-
tion may even irritate particular organs, accord-
ing to its nature, as the heart, the urinary, and
genital organs ; and the physical effect may in
its turn be a source of irritation to other parts.
The mental emotion, also, may be of so vidlent
a nature as to give rise to convulsions, or alter-
ed sensibility of remote parts, previously to
vascular or other disorder of a general kind
having been produced.

62. In estimating the influence of moral or
physical causes in exciting local or general irri-
tation, too great importance should never be
attached to one, or even two causes only, with-
out endeavouring to detect others, or compri-
sing the various predisposing circumstances in
our pathological estimate. Every influence or
occasion ought to be recognised and duly weigh-
ed ; for, upon the evidence we obtain of each,
must a principal part of our indications of cure
be founded.

63. IV. Treat.vient OF Irrit.^tion. — Theiw-
dications, as well as the means of cure, or of
alleviation, of both local and general irritation,

must entirely depend upon the knowledge that
is obtained of the causes, of their individual
and conjoint influence in producing the existing
effect, and of the extent of functional or struc-
tural disease which has already resulted. It is
manifest, from these and other considerations,
that the indications and means of cure of irri-
tation must, in order to be appropriate and ben-
eficial, have strict reference to the several pre-
disposing and exciting causes, and to the exist-
ing morbid conditions of each case. However
closely observant, however experienced the
writer may be, he cannot state these so as to
apply to all the circumstances of such cases as
they are daily occurring in practice. He can
only assign those which are the most important
and the most applicable to the more usual oc-
currences, leaving the reader to modify them,
or even to add to them, according to the emer-
gencies or the variations presented by particu-
lar instances.

64. There is no class of diseases in which
the fundamental principle in therapeutics, of
avoiding or removing, subduing or counteracting
the causes, is so necessary to be observed, or
so difl!icult to be practised, as in this very im-
portant and numerous class ; and none which
requires greater physiological knowledge, or a
more sagacious recognition of healthy and mor-
bid sympathies than this does. Thus impressed,
I have been led into a fuller exposition of the
pathological relations and causes of irritation
than may appear necessary to many. It seems,
however, that this procedure was not the less
necessary that it was difficult, and either avoided
by nearly all preceding writers, or treated of in
a most empirical manner, or, at least, with a less
strict reference to the early, the intimate, and
the consecutive changes characterizing the dis-
eased condition in question — with a less regard
to the actual procession of morbid phenomena
than the existing state of physiological knowl-
edge warranted. In entering, therefore, upon
the treatment of a case of local or constitu-
tional irritation, it is necessary not only to as-
tertain fully, and to estimate justly, the predis-
posing and exciting causes, with the view of
removing or counteracting them, but also to
trace the origin, the various relations, and the
obvious and probable efl^ects of this condition,
and to consider them in connexion with the
states of vascular action and purity, and of vital
power or resistance, and with the sympathies ex-
isting between distinct organs and distant parts.

65. i. Treatment of Irritation with reference la
removing, subduing, and counteracting the Caiis-
es. — Many of the causes admit of removal, oth-
ers can be counteracted merely ; and where the
former cannot be accomplished, the latter must
be attempted. In many cases, certain only of
the causes may be removed, and the others may
be either counteracted or sulxlued — a circum-
stance which should not be overlooked in fra-
ming our plan of cure. The first part of this in-
dication requires no remark, but the latter de-
mands farther notice. In order to subdue or to
counteract irritation, the means should be applied
with strict reference to the nature of the causes,
to the state of the oeconomy, and to the seat
and state of irritation. The means which are
to be thus employed may be divided into two
classes. 1st. I'hose which are strictly locals or
topical ; and, 2d Those which act more or less

IRRITATION— Treatment op.

711

tonslitiLlionally, or upon one or more of the gen-
eral systems of the frame.

66. A. Of the means applicable to the seal of
Irritation. — These consist chiefly of emollients,
anodynes, or sedatives, and narcotlr.s ; in some
instances of rt\frigerants, of stimulants or irri-
tants, and of cvacuants. The former of these
admit of being variously combined. It is in
comparatively few cases of irritation that these
means can be applied to the part primarily af-
fected ; but where this may be done, it should
never be neglected. — a. Under the head emoll-
ients may be comprised all the modes of em-
ploying moisl heat, or of conjoining moderate
warmth with humidity ; as the use of fomenta-
tions, warm vapour, and poultices. — b. Ano-
dynes and narcotics are indicated chiefly in con-
nexion tcith the former, the particular agent be-
ing suggested by the nature of the cause and
the seat of affection. This combination exerts
a more sedative influence on the local disorder
than either would if employed singly. Thus,
warm water, vapour, fomentations, or poultices,
with henbane, conium, belladonna, poppies,
camphor, &c., are more efficacious than those
emollients used simply. It should not be over-
looked, that protection from the action of the
air aids many of these in their beneficial opera-
tion. — c. Refrigerants are much less efficacious I
than the foregoing in removing local irritation,
although they act, like them, chiefly upon the
sensibility of the part ; and, in order to be useful,
they should be constantly applied. Refriger-
ants are most beneficial when irritation is
about to excite either hajmorrhage or inflam-
mation, and they may then especially be con-
joined with various asiringents and sedatives, as
the preparations of lead, of zinc, of opium, &c.

67. d. Stimulants, or even irritants, are some-
times useful in subduing local irritation, but it
is often difficult to determine the particular cir-
cumstances in which they should be resorted
to. When the irritating cause is of a poison-
ous, septic, infectious, or contaminating or spe-
cific nature, then stimulants, or even the more
powerful irritants, are generally beneficial.
Thus, camphor, ammonia, the turpentines, the
chlorides, the nitrate of silver, and numerous
other vegetable and mineral substances, are
often of service when applied to a part irrita-
ted by any of these causes. In such cases,
the artificial irritant, if sufficiently energetic,
supersedes the action of the morbid one, espe-
cially if it be employed before the organization
of the part and the vital powers have suflTcred,
or before morbid sympathies have been devel-
oped ; and even in these circumstances they
may greatly aid the constitutional means of
cure. The stimulus, even of dry heat, may be
useful in relieving irritation when judiciously
employed, or conjoined with other agents.
When heat is indicated purely as a stimulant,
or even as an antispasmodic and sedative, these
will often be most useful when applied in a dry
form. The combination of stimulants with
narcotics is sometimes of use, even locally, in
many cases of irritation, attended by pain or
spasm, and it will he seen in the sequel that this
combination is still more beneficial when pre-
scribed internally, or constitutionally. In most
cases of irritation manifested chiefly in the
nervous systems, this combination is especially
indicated, and is often not less efficacious

when topically than when constitutionally em-
ployed.

68. c. Eoacualion of the vessels of the part
alTucted, or of fluid effused in the areola; of the
tissue, is often of great service in an advanced
period of irritation. In such cases, distention
of the capillaries and of the tissues by the ef-
fused fluid, conse(|uent upon the action of the
irritant, perpetuates the morbid state, or even
increases it ; and in every instance it heightens
the constitutional and sympathetic effects of
the local affection. This is more particularly
remarkable where joints, fibrous or sero-fibrous
structures, or deep-seated parts, or tissues
bound down by aponeuroses, are so irritated as
to give rise to capillary distention or serous
effusion. In cases of this description especial-
ly, the use of emollients, anodynes, and narcot-
ics, will often beneficially follow the judicious
local evacuation of the distended vessels, or of
the effused serum.

69. B. The constitutional or more general treat-
ment of irritation consists chiefly of the use, 1st,
of agents calculated to lower or subdue, not
only the local affection, but also its sympathetic
and constitutional effects, by their direct or spe-
cific operation ; 2d, of such means as will ex-
cite irritation in a particular part or viscus, and
thereby supersede or reduce the primary affec-
tion ; 3d, of those medicines which stimulate
or impart tone to the nervous and vascular sys-
tems, and thereby either subdue the local mor-
bid condition, or enable the constitutional pow-
ers to resist it until it subsides, either naturally,
or from the disappearance of its causes, or from
the influence of local treatment ; and, 4th, of
remedies which remove injurious materials
from the system, which promote the excre-
tions, and preserve the circulating fluids in a
state of purity. It is obvious that, in the more
severe and intense states of irritation especial-
ly, these several means require to be variously
conjoined, and to he aided by the topical meas-
ures already advised.

70. a. The means most useful in reducing local
or sympathetic and constitutional irritation are the
usual antiphlogistic remedies ; as low diet, ab-
stinence, vascular depletions, refrigerants, sed-
atives, and physical and moral quietude. These
are more particularly indicated when irritation
aflecfs the sanguine, the plethoric, and the ro-
bust, or when it has superinduced a state of
sub-inflammation, or of active congestion, or
of active haemorrhage, or of simple sanguine-
ous determination to an important viscus. In
opposite circumstances, especially in the debili-
tated ; in the nervous, melancholic, lymphatic,
and irritable temperaments ; in persons with a
poor, or deficient, or morbid state of the blood ;
and for those who have long suffered, or who
are suffering from depressing influences, the
lowering measures now enumerated generally
increase the local irritation, and even hasten
and augment its sympathetic and constitutional
effects. By lowering the constitutional pow-
ers, resistance to the extension of the disorder
is equally weakened. In cases of this kind, the
more restorative measures about to be noticed
(^ 76) are required. Where the remedies com-
prised under this head are indicated, the choice
of them must altogether depend upon the causes
and nature of the case ; but generally they
should be cautiously prescribed, and they should.

712

IRRITATION— Treatment op.

be neither repeated nor persisted in, even when
indicated, without being combined with narcot-
ics, or with antispasmodics, according as mor-
bid sensibility or spasm may be the consequence
of irritation. In cases where want of sleep or
mental irritation attends this affection, the state
of circulation in the head should receive atten-
tion ; and if these symptoms are clearly not ref-
erable to increased vascular action in this quar-
ter, then narcotics or anodynes, sometimes con-
joined with alkalies, are of great service, and
reduce both the local irritation and the nervous
affections consequent upon it. In cases of
spasm, as well as of morbid sensation, anodynes
and narcotics are nearly equally serviceable ;
but, in the former especially, a combination of
them with those stimulants commonly called
antispasmodics is productive of great benefit.
When these symptoms are violent, without vas-
cular determination to the brain, antiphlogistic
and lowering means are generally prejudicial,
the opposite measures about to be noticed being
the more appropriate. In the circumstances
just noticed, a recourse to alkalies or their sub-
carbonates, with anodynes, is often of service,
particularly when the urine is thick, deposites
a sediment, is acid, and when the stools are of-
fensive, and the skin foul.

71. b. Irritation artificially produced in an or-
gan or part remote from the primary seat of mor-
bid irritation sometimes supersedes this latter
state. The principle of eomiter-irritation, of
vascular derivation, of artificial irritation, &c.,
has been long recognised in medical practice,
has been variously denominated, and various
means have been used in carrying the principle
into effect. It is, when judiciously prescribed,
more serviceable in disorders of irritation than
in any other class. The agents employed with
this intention may be divided into, 1st. Those
which irritate internal organs, and are servicea-
ble in consequence, chiefly, of this mode of ac-
tion ; 2d. Those that are applied externally with
this intention. — a. Of the former, (a) drastic pur-
gatives are the most commonly used, and some-
times most beneficial. They not only give rise
to an amount of irritation occasionally suffi-
cient to supersede the original affection, but
they evacuate accumulated morbid secretions
or faecal matters which either predisposed to
or otherwise contributed to cause the disorder.
Their good effects may partly, also, be imputed
to the vascular determination to the digestive
canal, and consequent derivation from the seat
of irritation produced by them. It is princi-
pally, however, when disorder is seated in parts
intimately sympathizing with the intestinal ca-
nal that they are the most useful. If it is seat-
ed in the nervous centres, or if it affects sensa-
tion or muscular motion, cathartics energeti-
cally employed afford great relief, as shown in
the articles on Neuralgic Affections, Teta-
nus, &c. — (i) Emetics are, upon the whole, less
serviceable than cathartics ; yet they are of
much use for irritation of the respiratory or-
gans, especially for hooping-cough, asthma,
croup, and for all spasmodic affections of the
larynx and bronchi consequent upon irritation
of the nerves of these parts. Of cathartics and
emetics it may be remarked, that a cautious
recourse to them — in some cases a frequent
repetition of them — is often necessary to the
removal of the irritation produced by morbid

secretions accumulated in the gall-ducts and
bladder, or even in the cells of the colon, or in
the cajcum. — (c) The more irritating diuretics,
as turpentine, cantharides, &c., are sometimes
decidedly beneficial in many disorders of irrita-
tion ; and, according to my experience, they
are most so when the irritation gives rise to
spasmodic or convulsive actions, as in trismus,
convulsions, hooping-cough, &c. ; but, in order
to be thus useful, they should be given so as
to produce a marked operation on the urinary
passages. I have frequently seen a very man-
ifest improvement of states of these diseases
as soon as the urinary organs became irritated.
— (d) Salivation may be considered as one of
the modes of internal irritation and derivation,
especially when maintained for a considerable
period. Mercurial salivation is, however, more
appropriate to inflammatory diseases than to
disorders depending upon irritation, unless, in-
deed, the latter tend to the former character,
and affect the states of vascular action either
generally or locally. Irritation, also, when pro-
ductive of hasmorrhage, is often most success-
fully combated by mercurial salivation of a
slight form, when it may be readily produced,
and without having recourse to a too free ex-
hibition of this mineral. In the slightest forms
of irritation, especially those affecting parts
about the face, mouth, &c., artificial excite-
ment of the salivary glands by pyrethrum or
other sialogogues may be of use.

72. B. External derivation or irritation has al-
ways been prescribed for disease ; but in recent
times it has been resorted to by empirics and
impostors, who have employed it injudicious-
ly, and often injuriously. It is appropriate in
most cases of irritation, in some form and mode
or other; yet much discrimination is necessary
to a beneficial recourse to it, in the choice both
of the irritant and of the situation to which it
should be applied. The stage of the disorder
in which it is most likely to be serviceable, and
the other means of cure which should be pre-
scribed in aid of it, also deserve consideration.
In the more acute and continued cases of dis-
order, and when it is desirable to produce an
immediate effect, then the extemal irritants
which are most energetic, as hot turpentine
epithems and embrocations, mustard poultices,
blisters, moxas, stinging by nettles, mustard
pediluvia, &c , are also the most useful; but,
in the more chronic, remittent, or intermittent
states, it will be necessary either to repeat
these applications oftener than once, or to
have recourse to others which, although slower
in their operation, are more permanent in their
influence on the complaint, as setons, issues,
and artificial eruptions, produced by croton oil,
by tartar emetic ointment, or by other means.
Some of these modes of producing external ir-
ritation require a few remarks.

73. a. Epithems of warm flannels, soaked in
spirits of turpentine, produce an almost imme-
diate redness and a burning sensation of the
part on which they are applied, and are espe-
cially beneficial in irritation of internal organs,
in painful or spasmodic affections, and particu-
larly when there is risk of inflammatory action
or haimorrhage being induced. They may be
frequently repeated in some cases, and they
then usually slightly vesicate or excoriate the
surface of the part, the external inflammation

IRRITATION— Treatment of.

718

thus produced soon subsiding, and they often
procure a copious perspiration. Stinging bij
nettles was formerly much used, and is an im-
mediate and often very efficacious mode of ex-
ternal derivation, and is applicable to the cases
for which mustard poultices are prescribed.
Mustard pcdiluvia, or mustard manuluvia, the
water being as warm as it may be endured, and
mustard poultices, are of service chiefly in cases
of slight irritation, and before vascular excite-
ment has been produced, or after it has been
in great measure subdued. These means are
seldom of much service when vascular excite-
ment is considerable.

74. b. The external irritants which are slow
in their action are beneficial in consequence
rather of their permanent influence, and the
discharge they occasion, than of the amount
of irritation or inflammatory action produced
by them. This is especially the case with sc-
ions and issues, in all the various forms in which
they are made or kept in action. One of the
best modes of forming an issue is by applying
the decorticated bark of mezereon, previously
moistened, over the part selected, and by re-
newing the application daily, or by placing the
common issue-pease under the plaster covering
the denuded or ulcerated part. When it is de-
sirable to produce a free discharge and much
artificial irritation at the same time, then open
blisters, large issues, or the antimonial ointment
may be prescribed. Croton oil, employed so as
to occasion free pustulation, and other appli-
cations calculated to excoriate the surface and
to give rise to a free discharge from it, as vari-
ous combinations of concentrated acetic acid
and oil of turpentine, or preparations of ammo-
nia, are severally of use when judiciously pre-
scribed and applied, and when aided by appro-
priate internal means.

75. c. Most of these modes of producing ex-
ternal irritation and derivation from the primary
seat of disorder are indicated, either before vas-
cular action has been excited by the primary
affection, or after it has been subdued, or in a
great measure subdued by suitable treatment.
As long as inflammatory action exists, or as
long as the primary irritation may be greater
than the amount of external irritation that can
be prudently excited, but little benefit will re-
sult from the practice, unless the discharge
procured by its means assist its influence, or
compensate for the deficiency in the amount
of irritation. In such instances the artificial
irritation is seldom productive of that amount
of vascular afflux or determination capable of
being decidedly beneficial. When, however, a
copious discharge is produced and maintained,
the internal affection will often be removed, if
it does not amount to disorganization or serious
structural change ; but when these changes
have taken place, the amount of discharge will
often only hasten the unfavourable progress
of the malady, and sink the patient. In all such
cases it is important to watch carefully the ef-
fects of this mode of treatment. When morbid
irritation has given rise to increased vascular
excitement, external irritation and derivation
are seldom successfully procured. In these
cases they only augment the morbid vascular
action, and are prejudicial, or, at least, ineffica-
cious, in proportion to the degree in which the
vascular system is excited.

II. 90

76. C. The remedies which stimulate the ner-
vous energy and impart tone to the vascular sys-
tem — a, are generally of service in diseases of
irritation when the vascular system is not ma-
terially disturbed, or when it is excited to in-
creased action, with a diminution of power, and
with evidence of a morbid state of the blood.
When irritation has been followed by great
frequency of the heart's action, irritability and
muscular power being much impaired, and the
pulse soft and open, or expansive, then the
more energetic stimulants or tonics, selected
with reference to the circumstances of individ-
ual cases, and conjoined with means which
may promote the action of the emunctories,
and counteract morbid changes in the circula-
ting fluids, are generally of the greatest service.
They increase the vital resistance to the exten-
sion of the sympathetic effects of irritation,
and enable the vital energies to overcome the
primary morbid condition, or to resist its inju-
rious influence until it subsides under the local
or other means of cure, or from other influ-
ences. The several preparations of cinchona,
or of other tonic barks, quinine, camphor, am-
monia, the chlorate of potash, the chlorides,
the alkaline carbonates, the hydro-chloric acid
and ether, wine, opium, alcoholic preparations,
the turpentines, Cayenne pepper, cajeput oil,
&c., and the numerous remedies more particu-
larly mentioned in the Treatment of Typhoid
Fevers (<5 530), and of Diffusive Infl.\mma-
TioNs {{) 236), are more especially indicated in
this state of disease.

77. b. When irritation gives rise to extreme
pain, to the more violent forms of neuralgia,
or to convulsive or spasmodic actions, the most
energetic and permanent tonics, variously com-
bined, according to the states of the excreting
viscera, are also then more beneficial than a
lowering treatment; but these remedies should
be aided by the most active narcotics, and by
suitable local means. In such cases, brisk
cathartics, followed by quinine, or the prepara-
tions of iron, or of arsenic, camphor, the alka-
lies, or alkaline carbonates in large doses, am-
monia, &c. ; and these, aided by opium, mor-
phia, henbane, colchicum, aconite, &c., pre-
scribed either internally or externally, or en-
dermically, according to circumstances, are the
m-ost efficacious remedies, particularly when
judiciously combined with one another, or with
other medicines. Whenever pain or convul-
sion is violent, inflammation is not present ;
but the irritating cause evidently acts most en-
ergetically upon the nervous system ; and the
means employed to overcome or remove it
should be equally energetic, and so selected
and combined as to act upon the source and
seat of irritation, and to remove the morbid
impression made by the cause of it. In some
cases, particularly those of extreme pain, al-
ways affecting the same nerve, treatment is
not permanently efficacious, although it is gen-
erally of temporary service, because the affec-
tion depends upon mechanical or irremoveable
irritation, near the origin, or in the course of
the nerve. In severer cases of spasm, or of
convulsion, it is, upon the w-hole, not much more
successful ; and is even almost equally hope-
less when the complaint depends upon similar
causes, or upon structural changes in the head,
or spinal column. In all such cases, the means

714

IRRITATION— Treatment of.

of cure sliould not be too weakening, and san-
guineous evacuation should be cautiously prac-
tised, even although local plethora, or vascular
determination to the nervous centres may ex-
ist. Local depletions, or small bleedings, coun-
ter-irritation and derivation, both internal and
external, tonics, anti-spasmodics, narcotics,
&c., are more beneficial than other measures.
Some years since, a gentleman was sent to me
from the country by his medical adviser on ac-
count of neuralgia of the occipital nerves ; I
considered it, from the history of the case, to
be dependant on a permanent cause of irrita-
tion about the base of the skull. External
derivation, and the other means already ad-
vised, were prescribed, and he continued to im-
prove for two or three years. During a visit
to town, he was exposed to several sources of
disorder,and in the evening he was seized with
violent convulsions. The surgeon called to
him bled him to a very large amount ; and on
the following day, when I saw him. his pulse
was very quick, irritable, extremely compressi-
ble, and furnishing all the indications of much
excitement, with defect of power. His man-
ner and answers to questions were hurried,
quick, and unusual. I expected a return of the
seizure, or paralysis, or apoplexy, in tlie course
of a few days ; but he continued to improve
slightly for some months, when hemiplegia, fol-
lowed by apoplexy, soon terminating life, took
place. Numerous otlier illustrations of this
principle might be adduced if my limits could
admit of them.

78. D. Remedies which remove Injurious Mat-
ters, promote Excretion, and correct Morbid States
of the Blood. — Many of the substances that evac-
uate excrementitial irritating matters also ex-
ert a salutary derivation, as respects the vas-
cular afflux or determination. The old doc-
trine, " ubi irritatio ibi fluxus," is correct in all
situations, and in every sense, and particularly
when the irritant is applied to mucous surfaces,
and acts upon excreting glands. During many
states of irritation, particularly when vascular
action is materially excited by it, absorption is
remarkably active, and morbid secretions accu-
mulated, either in the biliary passages or in the
intestines, especially in the cells of the colon
and cfficuin, are more rapidly than in other
circumstances conveyed into the circulation,
thereby either favouring the production of, or
actually producing constitutional disturbance
of a serious nature consecutively upon the lo-
cal irritation. The more stomachic, tonic, and
alterative purgatives are essentially necessary
in such circumstances, particularly combina-
tions of the compound infusions of gentian and
senna, with alkaline carbonates ; the spirits of
turpentine, with or without castor oil ; and oth-
er medici[ies which produce a restorative, as
well as an cvacuant effect. In all instances of
impaired excretion, or of excrementitial ac-
cumulations in the circulating fluids, either
contemporaneous with, or consequent upon lo-
cal or constitutional irritation, the exiiihition of
stomachic purgatives, and the alternation of the
more powerful tonics, arc extremely servicea-
ble. In this state of actual disease, the chlorate
of potash, chlorides, hydrochloric aether, cam-
phor, ammonia, the alkaline carbonates, and,
when vascular action is excited, the nitrate of
potash, the solution of the acetate of ammonia,

and other stimulants, either separately or pref-
erably, in conjunction with quinine, or with ton-
ic infusions or decoctions, or with one another,
according to their several compatibilities, will be
found most beneficial, provided that the actions
of the emunctories be at the same time duly
promoted, and morbid accumulations evacua-
ted. In cases where irritation is attended by
accumulations of excrementitial matters in the
blood, not only should the bowels be freely
acted upon by the means just mentioned, but
the kidneys ought to be excited by the more
energetic diuretics, as the turpentines, the al-
kaline carbonates, the nitric or hydro-chloric
ffithers, &c. When local, or even constitution-
al irritation is attended by deficiency of blood,
or by a deficient proportion of haematosine, then
the preparations of iron, with alkaline solutions,
as the mistura ferri compnsita, or the ferri am-
monio-chloridium, the ferri potassio-tartras,
&c., will be requisite, in addition to the other
means which the circumstances of individual
cases will suggest.

79. E. Alteratives and deohstruents, either
alone, or conjoined with gentle restoratives,
or with mild tonics, or with laxatives or ape-
rients, are of the greatest service in the more
chronic and slight forms of irritation. The
most useful of these are Plummer's pill, either
alone or with soap and extract of taraxacum ;
the hydrargyrum cum creta, similarly pre-
scribed ; the liquor potassa?, or Br.^ndish's al-
kaline solution, with any of the concentrated
preparations of sarsaparilla, or with taraxa-
cum ; and the solution of potash, with the hy-
driodate of potash. The sub-borate of soda,
either alone or with the bitartrate of potash,
or both these with taraxacum, are of service
for irritations of the biliary organs. A com-
bination of several of the foregoing medicines
with camphor, henbane, belladonna, or coni-
um, or with any of the preparations of opium,
according to the peculiarities of particular ca-
se-s, is often beneficial, especially when irri-
tation is attended by increased sensibility.
When there is much irritation of the cutane-
ous surface, the alkalies and their carbonates,
camphor, prussic acid, the narcotics just enu-
merated, with emollients, &c., employed both
internally and externally, should never be over-
looked.

[In nothing is the skill of the practical phy-
sician more clearly manifested than in distin-
guishing irritation from inflammation, and suc-
cessfully combating it with appropriate reme-
dies. Dr. B. Travers, in his able work on
" Constitutional Irritation," led the way to cor-
rect views on this most important subject ; and
Marshall Hall, in his more recent essay, en-
titled " Researches on the Effects of Loss of
Blood," brought forth facts and observations
of the highest practical import, which have
been also confirmed by the publications of Drs.
Abercrombie, Gooch, and others. With these
views, American physicians, we believe, are
very generally acquainted ; but yet we have so
frequently witnessed erroneous treatment, from
incorrect pathology — from mistaking simple ir-
ritation for active sthenic inflammation, that
we deem it proper to add a few remarks on
this subject, supplementary to those of our au-
thor. We have found, in a practice of many
years, that it is not always easy to discriminate

IRRITATION— Treatment.

716

in these cases, from tlic fiict that excessive
irritability, as mainiaiiied by Bkoussais, very
often depends on intlamination, or hypera;mia ;
it may he latent or chronic, and the irritation
hence arising will accordingly be successfully
combated by antiphlogistic measures, as evac-
uants, revulsives, and contra-irritants. We
do not, however, believe that blood-letting, ei-
ther general or local, is as beneficial, or as fre-
quently applicable in the treatment of these
cases as is generally supposed. We are to
bear in mind the remark of Mr. Travers, that
" extreme susceptibility, and consequent over-
activity, are invariably coupled with, and most
probably dependant on weak and insufficient
powers of constraint and resistance. The same
principle which renders a part over-irritable
renders it over-active." Medicines are not
anti-irritant in proportion to their antiphlogistic
effects, and therefore, as Dr. Williams has
remarked, where irritation predominates over
inflammation, those are to be preferred which
act on the nervous as well as on the vascular
functions. Physicians, especially those ol the
younger class, are in danger of regarding pain
as necessarily indicative of inflammation, and
hence calling for depletory measures ; whereas
it oftener is the result of nervous derange-
ment, and calls for soothing and anodyne rem-
edies.

The first rule to be laid down in the manage-
ment of this affection, which can scarcely be
called a specific disease, is to remove the irri-
tating cause. This will generally suffice for
the perfect cure of the patient. Thus, emetics
are successfully employed to remove irritating
matters from the stomach ; purgatives from
the bowels ; acidity is relieved by an alkali ;
the irritation of dentition by lancing the gums ;
of worms, by anthelmintics ; of a deep-seated
abscess, by the escape of the purulent matter ;
of hernia, by a division of the stricture ; of
stone in tlie bladder, by its removal, &,c. But,
unfortunately, as every practitioner must have
observed, irritation, when once established,
propagates itself, so as to become independent
of its first cause, and we here have a compli-
cation more difficult to manage. If now we
are ignorant of, or cannot reach the cause, we
must endeavour to diminish the irritability of
the system, which is to be done by corrobora-
ting measures, as pure air, exercise, cold and
shower bath ; vegetable and mineral tonics,
with anodynes and other soothing remedies.
As irritation results from a preponderance of
nervous mobility, those agents which give tone
and strength to the muscular system will un-
doubtedly jirove the most efficient remedies for
its removal. As a late writer has observed,
under the influence of tonics, disposition and
power to act will go together, and within due
bounds produce the harmonious balance of even
health. Whether certain of them possess a
specifically sedative property towards the ner-
vous system, or whether this is their secondary
effect, after their tonic and astringent influence
on the vessels, is beyond our means of decis-
ion ; but the fact is not less ascertained than
important, that the continued use of nitrate of
silver or sulphate of copper will cure the epi-
leptic convulsions independent of organic caus-
es, and often diminish them where the cause
is irremoveable, by lowering in the nerves their

susceptibility to its impressions. Thus, like-
wise, bark, carbonate of iron, arsenic, sulphate
of zinc, or sub-nitrate of bismuth sometimes
remove the painful or spasmodic irritations of
tic douloureux, hemicrania, sciatica, chorea,
and gastrodynea, which the most powerful ano-
dynes, antispasmodics, and counter-irritants
fail to effect. The stomach and intestinal ca-
nal, also, under the influence of a bitter tonic,
will often lose various signs of irritation, which,
however they may occasionally be accompa-
nied by slight hyperajmia or fancied inflamma-
tions, owe their being to weakness and want
of tone. The cold shower or plunge bath, or
cold ablution, is another efficacious tonic ; the
more eligible, often, because, without loading
the system with medicine, it rouses it to the
exertion of its own powers in a vigorous vas-
cular reaction, under the habit of which nervous
mobility is physically forgotten, and ceases.

It is highly necessary that practitioners
should be cautioned against resorting to anti-
phlogistic measures in these cases, although
temporary relief sometimes follows their em-
ployment. When local pain returns after bleed-
ing, it will often yield to fomentations and
morphia, or hyoscyamus internally, when the
repetition of the bleeding would entirely fail in
procuring relief We believe, with Williams,
that there are frequent pseudo-inflammations
arising in irritable states of the system which
are best relieved by sedatives, a judicious sup-
ply of nourishment, and an exclusion of all ex-
citing or disturbing agencies ; and that we oc-
casionally meet with diseases following excess-
ive evacuations which put on the semblance
of violent pleurisy, pericarditis, arachnitis, or
hydrocephalus, and which may be completely
subdued by hyoscyamus or opium, with a sus-
taining nourishment, such as sago, arrow-root,
or jelly, with small quantities of brandy or wine.
The state of the circulation, as indicated by the
pulse, is here to be our guide ; and the local
pains, palpitations, disturbance of the mind,
with beating or noises in the head, should be
viewed as partial reactions, to be subdued by
opium or hyoscyamus, rather than by the lan-
cet and evacuants.*]

* [In illustration of some of the preceding views, we quote
the following case from the New-York Jour, of Medicine,
vol. iv., p. 300, by LuTHER TicKNOR, M.U., of Salisbury,
Connecticut. " Mrs. A., about the midJle of November,
18-14, in washinof some small articles of dress, pierced the
end of the middle finger with the head of a threaded needle,
which she supposed penetrated the ball of the finger to the
depth of one third to one half inch. The first sensation was
that of numbness instantly following the infliction, extend-
insf up the arm to the axilla and front part of the shoulder.
This was followed immediately by numbness of the finders
of the other hand, and next with fuintness and vertigo, which
brought her pretty soon to her bed. Some mitigation of
these symptoms was produced by laudanum, so that I did
not see her until severe pain and febrile symptoms, op-
pressed respiration and gastric sinking, excited some alarm
for her safety, about forty-eight hours after the injury. I
found her with hurried, anxious breathings, very frequent,
obscure pulse, a moist surface, Avith temperature but little
increased, almost constant chilliness, and what the patient
called faintness. These two latter symptoms continued,
with very little variation, for five or six weeks. A diffused
swelling, not easily defined, occupied the upper porlion of
the ' peclor;ilis major muscle,' extending upward to the ar-
ticulation of the shoulder; certain points on this tumefac-
tion were excessively painful and tender to the touch.
These tender points changed their location from time to
time, so as to encourage tlie hope that some improvement
was going forward.

" The local treatment consisted of dry-cupping, epispas-
tics, fomentations, anodyne poultices, anodyne liniments,
&c., with very little apparent beuetit ; and yet anodyM

716

ITCH— Pathology.

80. F. The diet and regimen of diseases of
irritation require much attention. Wiiile vas-
cular action continues excited, the diet should
be mucilaginous, or farinaceous, light and cool-
ing, and suited to the powers of digestion and
assimilation. If, however, the vascular system
be not materially affected, and the functions of
the stomach are not much impaired, a small
proportion of light animal food may be allowed.
In the more serious states of constitutional irri-
tation, especially where there are marked asthe-
nia, and a disposition to chang**s in the state
of the blood, wine, and even alcoholic stimulants
are often necessary, in aid of the means above
recommended, in order to limit, or to prevent
the extension of the mischief, by exciting the
several vital endowments. In these cases, the
diet should consist chiefly of such articles as
are desired or relished by the patient, as being
the most likely to be digested without disorder-
ing the system.

81. Change of air: residence in a pure air,
exercise taken regularly and short of fatigue,
travelling, the use of those mineral waters, both
internally and externally, that contain the alka-
lies and alkaline carbonates and carbonic acid ;
the waters of Bath, Ems, &c., are usually ben-
eficial ; but mineral springs should be prescri-
bed with a strict reference to the specific forms
of these complaints, after a due experience of
their operation, and without being influenced by
prejudices, by fashion, by guide-books, or by lo-
cal interests. In many diseases of irritation the
factitious mineral waters prepared at Brighton
aave proved of great benefit, even in the range
of my own experience, having frequently pre-
scribed them since 1824. In most cases, how-
ever, much discrimination is requisite to the
procuring all the benefits they are calculated to
afford. In most instances, the milder waters,
as those of Ems, of .Saratoga, or of Salsbrunnen,
should be first prescribed ; and subsequently
Mie more tonic waters of Kissengen, Marienbad,
and Carlsbad, or of Eger, Pyrmont, or Spa,
having recourse occasionally to the waters of
Seidschutz or Pulna, when the bowels are tor-
pid, or the biliary functions impaired or ob-
structed. Several of these waters, also, may
be procured in London ; and at Brighton their
effects may be aided, in the cases that require
it, by warm salt-water bathing.

BiBLiOG. AND Refer.— De Magny, An k Vasorum aucta
aut imminuta Irritabilitate omiiis Morbus ? 8vo. Paris, 1752.
— G. Verschuir, De Arteriarura et Venarum Vi irritabili,
ejusque in Vasis Excessu, et iiide oriunda Sanguinis Direc-
tione abnormi. Groning., I'eiG.—Baldinger, De Irritabill-

poultlccs did the best. Internally, opium in some form, and
in large quantities, was indispensable throughout her treat-
ment. Profuse perspiration, subsultus, and incipient de-
lirium pretty early suggested the use of tonics, of which
sulph. of quinine was preferred, and freely and with advan-
tage. About six weeks after the injury, a slight fluctuation
was felt under the edge of the tendon of the pectoral muscle
wilhin the axilla. Forty-eight nours after it was discov-
ered, a spontaneous discharge, of at least eight ounces, of
rather thin purulent matter took place, and continued pro-
fuse from this oritice, and one made subsequently a little
lower down upon the chest, for about two weeks, when
constitutional and local symptoms pave place to returning
health. Immediately after tlie fluctuation was discovered,
Mrs. A. made free use of London porter, it being the only
stimulus of a diffusible kind her stomach would bear, and
this it bore to good purpose. Mrs. A. is now entirely well,
I believe, though, perhaps, the shoulder droops a litlle, from
the awkward position in which the arm was kept for a long
time, rather than from any imbecility in the muscles. A
deep depression marks the site of the abscess, showing a
pretty extensive condensation, or loss of cellular tissue."]

tate Morborum Genitrice. Jen., 1772. — A. Grant, Obser
vat. on the Use of Opium in Dis. of Irritability, 8vo. Lond.,
1785.— /. L. Gaultier, De Irritabilitatis Notione, Natura et
Morhis, 8vo. Hal., 1793 ; et Physiologic und Pathologie
der Reizbarkeit, 8vo. Leips., 1796. — Marcard, Beschrei-
bung von Pyrinunt, b. ii., p. 107. — M. Maraudal, Essai sur
les Irritations, 4to. Paris, 1807. — Consbruch, in Hufeland,
Journ. der Praet. Heilkunde, b. xiii., 3 St., p. 43.—/. G. h.
Henning. Ideen iiber Idiosyncrasie und Krankliche Reiz-
barkeit, 8vo. Gotha, 1812. — Humboldt, in M^moires de la
Society Medicale d'Emulation, t. i., p. 302 ; t. ii., p. 323. —
,1/on/a?fon. Diet, dcs Sciences M6dicales, t. xxvi. — P.J.
Mongeliaz, Essai sur les Irritations intermittentes, 8vo.
Pans, 1620. — F. T. V. Broussais, Traite de Physiol, ap-
plique a la Pathologie, 8vo. Paris, 1822; et Examen de
Doctrines M6dicales g6n6ralement adopts, 8vo. Paris, 2d
ed., 4 vol., 1829 ; et de I'lrntation et de la Folie, 8vo. Paris,
1828. — /. M. Goupil, Exposition des Principes de la nou-
velle Doctrine M6dicale, 8vo. Paris, \824.—Charpentier,
in Journ. Gentir. de Med., t. Ixxxvi., p. 6, 145.— /. Butler,
Remarks on the Irritative Fever of Plymouth Dock-Yard,
8vo. Devonporl, 1825. — Coutanceau, Diet, de M6d6cine,
8vo. Parie, t. xii. — V. Prus. De I'lrritation et de la Phleg-
masie, 8vo. Paris, 1825.— B. Trovers, Inquiry concerning
Constitutional Irritation, 8vo. Lond., 1826. — Also a Far-
ther Inquiry concerning Constitutional Irritation, and the
Pathology of the Nervous System, 8vo. Lond., 1835. — Roche,
Diet, de Med. Pratique, t. x. — R. Williams, Elements ot
Medicine, vol. i. ; On Morliid Poisons, 8vo. Lond., 1836. —
C. B. WHliams, Cyclop, of Pract. Medicine, 8vo. Lond.,
vol. ii., p. 875.

[Am. Bibliog. and Refer.— Various Treatises on Phys-
iology and Practice of Medicine, and occasional Essays iu
different Medical Journals.]

ISCHURIA. See Urine.

ITCH. — Syn. Psora, ■fupa (from ■^au, I rub,
or scratch). Scabies (from scabo, I scratch).
Phlysis scabies. Young. Ecpyesis scabies,
Good. Scabiola, Auct., Lat. Kratze, jucken
der haut, zaude. Germ. Gale, rogne, Fr. Rog-
na, Scabbia, Ital. The Scab.

Classif. — iv. Class, viii. Order {Cullen).
6th Class. 3 Order {Good). III. Class,
I. Order {Author in Preface).

1. Defin. — An eruption of distinct, slightly
acuminated vesicles, accompanied with constant
itching, caused by contagion, the eruption being
occasionally modified in character at its appear-
a7ice, or during its progress, and unattended by
constitxUional disturbance.

2. Recent writers have supposed that the
eruption mentioned by Galen, under the name
of ^upa, was really the itch ; but his descrip-
tion of it is more applicable to squamous than
to vesicular eruptions. The description, also,
which Celsus has given of scabies is by no
means distinctive of itch, and is more charac-
teristic of prurigo than of it. Neither these
writers nor Avicenna mention contagion as
attending the eruption thus named by them.
Guy de Chauliac, according to Rayer, was the
first to point out this important feature of the
disease. Subsequent writers have generally
noticed it, although several of them have not
distinguished between itch and prurigenous
affections. More recently, Willan, Bateman,
BiETT, and Rayer have given the history of
this eruption with much precision.

3. The modifications occasionally presented
by the itch, both on its appearance and during
its progress, have led to some difference in the
classification of it. Thus, it soniotimes as-
sumes from its commencement a papular form,
and during its course a pustular character.
Hence Willan and Bateman arranged its vari-
eties accordingly, and placed it among the pus-
tular eruptions, the varieties being the Papuli-
formis, Lymphalica, Purulanta, and Cachetica.
MM. Biett and Rayer, however, have more
accurately classed it with vesicular eruptions,
the vesicular form being its primitive and most

ITCH — Description op.

common state ; still it sometimes appears as a
papular eruption, and as such Dr. Paget has
arranged it. I shall here consider the disease
as commonly vesicular, and the modifications or
varieties presented by it as accidental or con-
tingent upon the peculiarities or circumstances
of individual cases.

I. Descrii'tiox. — This eruption generally ap-
pears first on the hands, between the fingers,
on the wrists, on the flexures of the joints, on
the abdomen, and on the insides of the limbs.
It is most commonly confined to a surface of
no very great extent ; and, in some cases, con-
sists only of a few vesicles dispersed between
the fingers and over the wrists ; but it may af-
fect the skin very generally. It does not occur
on the face or on the scalp. It is essentially a
contagious disease, and is neither epidemic nor
endemic.

4. 1st. Of its common vesicular form. — The
eruption generally takes place in children at the
end of four or five days from the period of con-
tagion ; but this is uncertain, for in weak or
delicate children it may be delayed beyond this
period, while, in the plethoric and sanguine, it
appears even earlier. It seldom occurs in
adults before eight or ten days have elapsed,
in spring and summer, or before fourteen or
twenty days in winter. It is longer in appear-
ing in the aged than in the young or middle-
aged, and it attacks in preference the situations
where the skin is most delicate.

5. The eruption commences with itching, at
first slight, of the parts which have been expo-
sed to contagion. The itching is increased
through the niglit by the warmth of the bed, by
indulgence in stimulating food, beverages, and
spices, and by whatever heats or determines
the blood to the surface. A number of small
points or spots, very slightly elevated above
the surface, now appear, and present a pale
rosy colour, with small acuminated vesicles on
each point or spot. If the vesicles be few, they
occasion but little pruritus, and preserve longer
their primitive form ; but if they be numerous,
the skin between each participates in the irri-
tation, and the itching becomes urgent. The
vesicles are then usually torn by the nails, and
allow their viscid serous contents to escape,
which concrete and form small, thin scabs,
slightly adherent to the skin. If the scratch-
ing has been violent, the scabs are black, and
resemble those of prurigo.

6. ii. Varieties or Modifications. — Owing to
peculiarity of constitution, to the amount of in-
flammatory action attending the eruption, to
the depth to which it extends in the tissues
composing the skin, and to the existing state
of health of the patient, itch presents certain
modifications which have been arranged into
species by Will.^n and Bateman. — A. The va-
riety denominated by them the Scabies Papuli-
formis, or rank Uch, is that in which the erup-
tion is more papular and inflamed at the base.
hut still presents a transparent apex, indicating
its vesicular character. When much irritated
by scratching, long red lines are left here and
there, and the fluid exuded from the abraded
vesicles concretes into little brown or blackish
scabs. In sanguine temperaments, and when
much irritated, a few of the vesicles assume a
pustular form, from the fluid contained in them
changing to a purulent matter.

7. B. The Scabies Lymphatica, oi watery itch,
differs from the foregoing chiefly m the ab-
sence of the papular character and of inflam-
matory redness, and in the larger size of the
vesicles. When the vesicles are ruptured by
scratching them, moist excoriations often form,
and, after a time, dark scabs. This variety
usually presents three stages, viz., the entire
vesicle, the excoriation consequent on its rup-
ture, and the scab covering the excoriated
part. It is not so frequently observed as the
former variety on the trunk, but is most com-
monly found collected on the lower parts of
the extremities, as the fingers, wrists, backs of
the hands, and sometimes on the feet and toes.

8. C. The Scabies Purulenla, or pocky itch, is
more distinct than the other varieties. The
round pustules into which scabies, in a few in-
stances, forms itself, resemble the pustules of
smallpox. They occur chiefly in children and
young persons who have been living on a heat-
ing diet, and who have been inattentive to
cleanliness. These pustules are distinct, with
an inflamed base, and considerably elevated ;
they maturate and break after a few days, hav-
ing then often attained a diameter of two or
three lines. The itching occasioned by them
is attended by more tension and smarting than
that of the other varieties. After they break
they often leave a cracked excoriation or ul-
ceration behind, or small fissures between the
scabs, the stiffness and heat of which cause
considerable uneasiness. The pustules rarely
appear on the trunk, but usually on the hands,
between the fingers, or near their flexures,
more rarely on the feet and at the bends of
the arms. They are largest on the hands and
betw-een the knuckles, especially between the
index finger and thumb ; they often coalesce,
and in these situations more especially, slight
fissures or cracks form in the concretions cov-
ering the excoriations or seats of pustulation.
This variety, in plethoric children, is some-
times attended by slight febril commotion.

9. D. The Scabies Cachectica, or scorbutic itch
of WiLLAN, is not, strictly, a variety, but mere-
ly an imprecise modification, produced by de-
bility and general cachectica, in consequence
of intemperance, poor living, and unwholesome
food, that assumes no very distinct or unvary-
ing character. As may be expected, from the
circumstances in which it occurs, it is the most
aggravated state of the eruption ; and is more
frequently than the true varieties, either form
of H hich it may assume, complicated with oth-
er eruptions, particularly with lichen, prurigo,
ecthyma, and impelifro. When itch occurs in
the dark races, it generally presents this state,
and is severe and obstinate — is rank and ex-
tensive, spreading rapidly over the body. As
thus met with, it has been noticed by Bontius,
and by Sauvages, who called it Scabies Indica.

10. E. The complications of itch often render
the diagnosis difiicult. Ecthyma is sometimes
associated with it, and more rarely eczema, but
is chiefly cured by the use of stimulating wash-
es or ointments. Scabies is most frequently
complicated with papular eruptions, particular-
ly with lichen, in the young, and when the vesi-
cles are generally or abundantly disseminated.
Prurigo is often associated with itch in the
more prolonged cases. Boils occasionally ap-
pear in the more severe instances. These com-

718

ITCH — Diagnosis — Causes.

plications, as well as a pustular state of the
eruption, are favoured by living on salt, acrid,
and fat meats, and by acrid applications to the
surface. Disorders of the digestive organs
sometimes prevent the full evolution of itch ;
or persons subject to these disorders, who
have caught this affection, often readily recov-
er from it when such disorders are aggravated
by errors of diet. Scrofula does not materially
modify scabies. In very unhealthy or cachec-
tic subjects it sometimes assumes a livid hue;
and, when its vesicles are crowded in any part,
they are occasionally associated with ecthyma
cackecticum.

11. F. The duration of this eruption depends
upon treatment. If left to itself it never gets
well, and may even continue through life when
thus neglected. In southern climates, and in
spring and summer, and in young, plethoric,
and robust persons, the vesicles of itch run
rapidly through their successive changes, when
not broken by scratching ; but their progress is
much slower in the north, in winter and autumn,
and in the bilious, melancholic, and cachectic,
and in the aged and infirm — in whom, also, it
is longer in appearing after infection. When
it is judiciously treated, and with strict atteu-
tion to cleanliness, and to the state of the lin-
en and clothes, it may be cured, in very recent
cases, in five or six days, and in the worst
cases in from ten to fourteen days to three
weeks ; but it may be protracted beyond this
period in the old, infirm, and cachectic, or
when it has been long in appearing. In some
rare instances, it disappears on an attack of
an internal inflammatory disease, and returns
again when that disease is removed. This cir-
cumstance, however, has been doubted, some
other eruption having been mistaken for the
itch. In general, this eruption exerts no influ-
ence upon internal complaints, nor do they pro-
duce any effect on it ; although an opposite
opinion has been long held by pathologists, and
is still entertained by a few.

12. II. Diagnosis. — It is of importance, not
only as respects the reputation of the practi-
tioner, but as regards the speedy recovery of
the patient, and the protection of the other
members of the family to which he belongs,
that a correct diagnosis between this eruption
and those which so closely resemble it should
be made. — A. Prurigo is most frequently con-
founded with the itch ; but, independently of
the former being papular, while the latter is
vesicular, prurigo is usually seated on the back,
shoulders, and on the outsides of the limbs, or
on the surfaces of extension ; while the itch
is observed chiefly on those of flexion, on the
wrists, and between the fingers. Prurigo, also,
occurs more frequently in adults and elderly
persons than itch ; its papula are flat, and when
abraded, a black spot of blood concretes on
their centres. The itching attending prurigo is
more vehement than that of scabies, more
stinging or smarting, and less pleasurable. The
former, also, is not contagious.

13. B. L;c/ic?iA-(Hi;)/<:x most closely resembles
the papuliform variety of itch. In the former
no vesicles can be detected in the summits of
the papulae, which pass away in a scurvy exfo-
liation, and do not give rise to dark scabs.
Lichen appears on the backs of the hands and
on the external surface of the limbs, and hard-

ly ever between the fingers. The itching at-
tending it is not severe, and the papulas preserve
the tint of the skin, while the vesicles of scabies
are of a pale pink ; the former being generally
crowded together, the latter being much more
distinct. Lichen is commonly accompanied
with some constitutional disturbance ; but it is
not contagious. The lichen urticatus is more
acute, and sometimes presents a few vesicles
among the papulae ; but its inflamed, wheal-like
papulae, and the deep tingling, rather than itch-
ing, sufficiently distinguish it.

14. C. Eczema, particularly C. Simplex, may
be confounded ivith itch ; but in the former the
vesicles are flattened and agglomerated in great-
er or less numbers, while in the latter they are
acuminated and generally distinct. The itching
of eczema is a kind of general smarting, or
stinging, very different from those exacerba-
tions characterizing itch. The former is usu-
ally produced by exciting or irritating causes,
the latter by contagion only.

15. The association of scabies with other
eruptions is of importance in the diagnosis.
Such complications may be merely accidental,
but they occasionally arise from the irritation
of scratching, and of applications to the erup-
tion. Vesicles of itch, pustules of impetigo or
of ecthyma, and furunculi are sometimes met
with in the same patient. The papulae of li-
chen, also, may be either contemporaneous with
itch, or consequent upon it. Scabies may even
coexist with syphilis, without having its char-
acters thereby modified, farther than has been
noticed when mentioning the variety called ca-
chectica. These combinations generally retard
the cure, as well as often increase the difficulty
of diagnosis.

16. III. Causes. — The great, and, perhaps,
only cause of itch, is contagion. The only
questions are, whether it does, in any circum-
stances, arise spontaneously, and what is the
nature of the infecting substance, or body.
These will be answered in the sequel, as far as
the state of our knowledge admits of answers.
Scabies is one of the most universally dissem-
inated contagious diseases, the momentary con-
tact of the fluid secreted by its vesicles being
sufficient to communicate the infection. It oc-
curs in every climate, in every season, in all
ranks and ages ; but is most common in the
poor and wretched, in persons negligent of
cleanliness ; in sailors, soldiers, in work-peo-
ple, dealers in old clothes, in tailors ; and espe-
cially in those crowded in jails, hulks, barracks,
workhouses, and factories. It rarely is observ-
ed in tanners, in dyers, and blacksmiths, or in
the families of the affluent. It always spreads
in consequence of contact, immediate or medi-
ate ; and of want of cleanliness.

17. Several instances of itch transmitted
from animals to the human species have been
cited ; but most of the diseases thus named are
inaccurately described, and arc of a very doubt-
ful character. M. MoaRONVAL adduces cases
of the communication of itch from the dog to
man ; but M. Rayer states that M. Leblanc
showed MM. Sabatier, Littre, and himself
dogs labouring under a disease called itch, con-
sisting of a number of small acuminated vesi-
cles, resembling those of scabies in the human
subject; and stated that the man who attended
them had not been infected by them, although

ITCH— Treatment of.

719

they communicated the disease to their own
species. Tiiis, however, is no satisfactory
proof of the non-comniiiiiicability of the affec-
tion from the dog to man. Mr. Yoi-att, whose
authority in this matter is the best possible, in-
formed the author that the itch may be com-
municated to the dog, and by the dog to man
and other animals, but that it is never sporadic
in the canine race.

18. AvENzoAR, and, long subsequently, In-
oRASsiAs and Jobert, hinted at the existence
of an insect in the vesicles of itch ; but Mouf-
FET first mentioned it in his Thealrum Insccto-
rum, in a particular manner. Several recent
authors have described it under the name of
Acarus scabiei. Hauptmann first published a
figure of it, and represented it with six feet.
Redi put the existence of this insect beyond
doubt, and, aided by G. Lorenzo and H. Ces-
TONi, examined numbers of them, having re-
moved them from the vesicles. Dr. Bonomo
gave the following deucription of it : This in-
sect moves with great vivacity ; has six legs,
and a pointed head, -irmed with two small
horns, or antennae, at the extremity of the mouth.
It is, he remarks, difficult to distinguish these
insects on the surface of the body, owing to
their minuteness, and to their colour resem-
bling that of the skin. They first insinuate
their pointed heads, and then move about, gnaw-
ing and pushing, until they have buried them-
selves under the cuticle, where they form a
kind of covered way of communication between
one point and another, so that the same insect
generally causes several watery pustules. The
above physicians also discovered the eggs of
these insects, and even observed their extru-
sion from the hinder part of the animal. The
eggs are white, nearly quite transparent, and
hardly visible. These insects, they remark,
pass readily from one person to another, by
mere contact, for, being very active, and often
on the surface of the skin, they readily attach
themselves to whatever they touch.

19. MoRGAGNi, Linnaeus, De Geer, Wich-
MANN, Waltz, and others confirm the above
description ; but, nevertheless, the existence
of these insects having been called in question,
M. Gales took up the subject, and his investi-
gations, which were witnessed by many mem-
bers of the Institute, farther confirmed the
above statement. The circumstance of Gali>
OTTi, Chiarijgi, Biett, Lugol, and Mouronval
having failed in finding these insects occasion-
ed fresh doubts of their existence ; but their
failure arose from having sought for them in
the vesicles. Mouffet had long before stated
that they are not found in the pustules, but by
their sides ; Casal had made nearly a similar
observation ; and Dr. Adams remarks, that they
are not found in the vesicles, but in a reddish
line going off from one of its sides, and in the red-
dish and firm elevation at the extremity of this
line, and at a little distance from the vesicle.
Mr. Plum'be supposes that the insect is unable
to live in the fluid of the vesicle, which is the
result of the irritation it causes, and therefore
escapes from it. Finally, M. Renucci, a med-
ical student from Corsica, showed, in 1834, the
physicians of Paris the mode of discovering this
insect, which is the same as that formerly sta-
ted by Dr. Adams. Since this time, M. Raver
remarks, the existince of the acarus of the itch

has been placed beyond a doubt. MM. Lemery,
Grab, and Renucci had each shown him the
mode of detecting it. and he had himself ex-
tracted several. M. Raspail has given an ex-
cellent description and figures of it ; and .M. A.
Gras has entered into researches as to the
share it has in producing this eruption. Al-
though it has been proved that, in almost all
who are affected with scabies, and who have
not been subjected to treatment, a certain num-
ber of sub-epidermic furrows, containing acari,
are to be discovered, it is also undoubted that
the number of these furrows and of these in-
sects bears no proportion to that of the vesi-
cles. It is, farther, rare to discover these in-
sects on the abdomen and groins, where the
eruption is, nevertheless, very common and ap-
parent ; and, moreover, scabies is known to
continue where no more acari are to be found.
The experiments made to ascertain whether or
not the acarus be the cause of the itch, or a par-
asite produced by it, are not altogether conclu-
sive.

[Dr. Watson remarks {Pract. of Physic), that
■" there is good reason for believing that the
parasitic animal is not merely a casual com-
panion, but the veritable cause of scabies. Va-
rious attempts have been made, and made in
vain, to produce the disease by inoculation of
the fluid from the vesicles. On the other hand,
transportation of the acarus has always excited
the eruption. These facts explain how it is
that the itch, though readily communicable by
direct contact or by fomites, is not communi-
cable through the medium of the air ; that fo-
mites long retain the contagious property ; and
that the disease is curable by whatever destroys
the acari.'"]

20. IV. Tre.\tment. — As the itch is never
spontaneously cured, but may continue even for
many years, the treatment should be decided
and unremitting. The experiments lately made
by M. Gras have thrown much light upon this
subject. They prove that a concentrated solu-
tion of the hydrioJate of potash kills the acarus
of scabies in the shortest time — in from four to
six minutes ; and he considers that ari ointment,
consisting of half a drachm of this substance to an
ounce of axunge, is the best remedy for the itch.
I have prescribed this ointment in several in-
stances, and have found it the most speedily
efficacious. This physician states that the
itch insect lives sixteen hours in the vapour of
burned sulphur, three hours in water, two hours
in olive oil, one hour in the acetate of lead, one
hour in pulverized brimstone, three quarters of
an hour in lime-water, twenty minutes in vine-
gar and spirits of wine, and twelve minutes in
a solution of sulphuret of potash.

21. Where scabies is uncomplicated and re-
cent, its cure is readily accomplished by local
applications, and without any preparatory or
constitutional means ; but where it is of old
standing, and associated with other eruptions,
or with an inflammatory state of the skin, and
particularly if the patient be young and pleth-
oric, a bleeding from the arm, soothing lotions,
and simple baths may be premised. Frictions
with the sulphur ointment {sulph. sublim. loti,
;viij. ; adipis prczp., ibj.), or with either of the
compound sulphur ointments {sulph. subl., sij. ; po-
tasstB subcarb., 3J. ; adipis, 5J. ; or sulphureti calcis,
3J. ; adipis, fj.), usually cure scabies in ten or

730

ITCH — Treatment of.

fourteen days. The compound sulphur oint-
ment is the next to the ointment witli hydrio-
date of potass in efficacy. M. Rayer advises
the compound sulphur ointment in the quantity
of two ounces daily, to be rubbed over all the
parts affected, the patient's skin having been
well cleansed with soap and water. The rub-
bing should be continued diligently for about
half an hour, morning, midday, and at night. .
If this be continued unremittingly, the eruption
may be cured in six or seven days. Helme-
RicH prescribed four ounces of the compound
sulphur ointment to be assiduously rubbed on
the parts affected in the twenty-four hours. An
ointment, consisting of sulph. suhlim. loti, fiij. ;
ammon. hi/dro-chlor., jij. ; adipis prcrpar. g.xiij , is
also an efficacious application. M. Derhelms
has found the solution of chloride of lime, gj. in
■water Oj., and used twice or thrice daily, very
efficient.

22. The plan of M Pyhorel, to add half a
drachm of the sulphuret of lime to a little olive
oil, and with this to rub the palms of the hands
during a quarter of an hour night and morning,
is also efficacious. Sulphureous loashes, as that
composed of potasses sulphurcti 5J., aqua Ibiij.,
of which an ounce is to be added to four ounces
of warm water, and applied to the affected parts,
also speedily effect a cure. These washes do
not soil the clothes like ointments, but they
often cause vesicular and papular eruptions.
Should these eruptions appear, or complicate
the itch, irritating frictions and applications
must be suspended, and tepid emollient baths
prescribed. In all cases of scabies, a few tepid
baths should follow the removal of the eruption.

23. Alcoholic sapo7iaccous u'ashes, acid oint-
ments and ivashes, artificial sulphureous baths, sul-
phureous fumigations, &c., and various other
means, have been recommended for the cure
of itch ; but they are less certain than the above,
require a longer period, and are more expen-
sive. Washes and ointments, the basis of
which are nitric acid and mercury, have occa-
sionally produced salivation and disturbance of
the digestive organs. The internal use of sul-
phur, or this conjoined with its external appli-
cation, has been long employed in this country,
and is efficacious and well suited to the puru-
lent form of scabies, as met with in children.
Hellebore and tobacco have also been recommend-
ed for the cure of itch, and are doubtless effica-
cious ; but they are hazardous substances, par-
ticularly where there is much excoriation, and
when prescribed for children.

[We have never found any difficulty in cu-
ring the itch, however severe, by sulphur oint-
ment. We mix with it a small quantity of oil
of bergamot, to disguise the smell, and a little
vermilion, to conceal the colour, and then di-
rect the patient to be rubbed all over carefully
at bedtime, especially over the parts affected,
and to sleep in a flannel dress. A repetition
of this practice, night and morning, for three
days will suffice for a cure. The patient is
then to be thoroughly washed with warm wa-
ter and soap, and the treatment is completed.]

24. Where itch is associated with general
cachexia, and is modified by this circumstance,
a judicious internal treatment should be con-
joined with external applications, and with
warm or tepid baths. In these cases the liquor
potasstB may be taken with sarsaparilla, or the

alkaline carbonates may be given with miW
tonics ; and an alterative dose of a mild mer-
curial may be prescribed occasionally at bed-
time. This treatment, in addition to the spe-
cific external measures already mentioned, is
also requisite when itch attacks the dark races,
among whom it generally proves a much more
severe and obstinate affection than in the white
races.

25. During the treatment, the diet should be
digestible and in moderate quantity. All acid,
heating, and fat articles, as well as stimulating
beverages, should be avoided. In order to pre-
vent a return of the eruption, and its spreading
in a family, the body and bed-clothes of the pa-
tient ought to be subjected to disinfecting pro-
cesses, as the fumes of sulphurous acid gas.
The linen should be changed frequently, and
the greatest attention paid to cleanliness.

[There is need of caution on one point : mer-
curial preparations of every kind should be laid
aside in the treatment of scabies, as they often
produce very dangerous consequences. Be-
sides the accidental eruptions to which they
often give rise, they are liable to occasion sali-
vation, engorgement of the salivary glands, or
even inflammation of the tongue. Cazenave
/regards the sulphuret of lime to be the most
generally beneficial application in these cases :
-ss., mixed with a little olive oil, and rubbed
twice a day over the part affected. The mean
duration of the treatment with this remedy is
fifteen days ; but it is only useful where the
eruption is limited and recent. We have known
Dupuvtren's lotion prove very successful : this
is composed of sulphuret of pota.ssa, jiv. ; sul-
phuric acid, 5SS. ; u-ater, Ojss. : mix. The af-
fected parts to be washed with the lotion twice
a day. The hellebore ointment, in the propor-
tion of one part to eight of lard, will usually
accomplish a cure in about two weeks. Hel-
merick's ointment will, in a large majority of
cases, cure in about ten days. This is the fa-
vourite remedy of .M. Biett, composed as fol-
lows : Sublimed sulphur, 3ij. ; sub-carb. potass.,
3i. ; lard, fi. ; M. ; jss. to be rubbed in night
and morning, and occasionally a tepid bath. In
children, soap water and artificial sulphur baths
are very appropriate remedies ; also sulphur
fumigations, especially as auxiliaries. Where
the itching is very troublesome, alkaline baths
usually afford very decided relief Dr. Bulke-
lev states {Am. cd. 0/ Cazenave and Schledel
p. 108), that the combination of sulphur with
soap, of a kind and quality to suit the taste and
the means of the patient, forms a convenient
and effectual mode of applying that remedy ;
and that he has combined it with the common
soft soap in dispensary practice with good ef-
fect. Emery gives the following recipe for an
ointment used at the St. Louis Hospital :
IJ Brown soap, f\. ; table salt, fss. ; alcohol, 5i. ;
vinegar, jij. ; chloride of lime, 3SS. ; M. He says
that it causes no irritation, does not soil the
clothes, has no unpleasant smell, cures in a
short time, and is cheap. (Bull. Gen. de Ther-
apcutique. May, 1836.)

Extensive experiments have recently been
made in the Berlin hospitals (Brit, and For.
Med. Rev., July, 1841), by which it is found
that a slight modification of the ordinary sul-
phur treatment accomplishes a cure with more
speed, certainty, and economy than any other.

KIDNEYS— Diseases of the.

721

One part of the flowers of sulphur was mixed
with two parts of soap, and suflicient warm wa-
ter to make into an ointment. The patients, af-
ter a warm bath of soap and water had been ap-
pHed, were placed, undressed, in a chamber icept
constantly at a temperature of 95'' Fa\\T., and
well rubbed with ihe ointment over all the parts
affected, three times a day, and then made to
sweat profusely by putting them into warm
beds. This system was continued for three
days and nights ; on the morning of the fourth,
each patient had a warm bath, and then, if not
cured, was provided with clean bed and body
linen, and put in a ward of ordinary tempera-
ture, in which the suspicious parts were still
rubbed with the ointment, and a warm bath
taken every other day. In general, no internal
medicines were given ; but the diet allowed was
reduced to a fourth portion, and water only
given to drink. In this manner, with but one
short interval, 1981 were heated and cured
between September, 1839, and February, 1840,
making the total number of days of treatment
15-890, which gives, on the average, 8 days and
a fraction for the cure of each patient, and for
the expense of each about two dollars. The
exact result was, that in 3 days there were
cured 42; in 4 days, 161 ; in 5 days, 333; in
6 days, 376 ; in 7 days, 207 ; and in more than
seven days, 589.

The treatment of these last was prolonged
by many circumstances which can hardly cast
discredit on the remedies. In many among
them, the itch was soon cured, but they re-
mained under treatment for the ulcers which
had come on from long neglect of it, or were
kept in the hospital till there was no chance
of the ulcers communicating the disease. Oth-
ers among them, after being cured of the skin
disease, had to be treated for other affections ;
and others, again, had their cure delayed by an
obstinate refusal to adopt all accessory treat-
ment. In the whole 15 months there occurred
only 8 cases of relapse ; less than ^ of 1 per
cent, of the cases treated, and in most of these
there was reason to suspect a fresh infection.
In no case did the treatment give rise to any
general disorder, or to the inflammations or
congestions which some have described as re-
sulting from it.]

BiBLIOG. AND UETEK.—Celsus, lit). V., Cap. 28.— Novus
Inde.x ill omnia quae extant CI. Galeni Opera, ful. Basil,
1562 ; art. psora, Scabies.— ftuy de Chauliac, Des Signes de
Scahie, Ac, trad, par J. Canappe, 8vo. Lyont, 1609. —
Willis, Pharinac. Ration., Par. I., s. 3, cap. 6. — Mouffet,
Theatrum Insectoruni, fol. Lond., 1634. — Bontius, De Med.
Indorum, lib, iii., cap. 17. — G. C. Bonomo, Sur les Cirons
ou Insectes de la Peau des Galeu.v, in Collect. Acadiim.
Etrangeres, 4to, t. iv., p. 574. — Bonomo by Mead, in Phil-
osoph. Trans., vol. xxiii., 1702. — Plenck, Doct. de Morb.
Cut., p. 42. — Uocderer, Dc Scabie, VIO. — Ettmuller, De
Scahie Programma, 6vo, 1731. — Helmirh, De Usu Interno
Olei Vitrioli dil. in nonnullis Scabiei Spcciebus, 4to, 1762.
— G. Casal, Ilistoria Natural y Medica dc el Princip. de
Asturias, 4to. Madrid, 1762. — Morgagni, De Causis et Sed.
Morb., lib. iv., cp. 55. — De Geer, Mem. pour servir A I'Hist.
des Insectes, 4to. Stockh., 1778.— Turner, Treat, on Dis.
of the Skin, ed. 4, p. 58. — Pentzlin, in Brit, and Foreign
Med, Rev., Oct., 1837, p. 514,— Wickmann, ^tiologie der
Kr9tze, 8vo. Hanover, 1786. — Adams, On Morbid Poisons,
4to. Lond., 1807, p. 299.— F. /. Becu, M6m. sur la DC-coc-
lion du Tabac, enipl. au Trait, de la Gale, vide Recueil Pe-
riodique, &c., t. i., p. 60. — Ranque, M(im. et Observ. Cli-
niques sur un Nouv. Proc('-de pour la Cu6rison de la Gale,
8vo. Paris, 1811.— Lc Koux, Traite sur la Gale, cfcc, 12mo.
Paris, 1809. — /. P. Frank, De Cur. Horn. Mob., t. iv., p.
165.— Ga/e, Essai sur le Diag. de la Gale, sur ses Causes,
&c., 4to. Paris, 1822. — T. Bateman, Pract. Synopsis of
Cutaneous Diseases, 7th ed., by A. T. Thompson, p. 280. —
Mouronvel, Recherche et Obser\-. sur la Gale, <Scc., 8vo.

II Si

Paris, 1822.— Lugol, Rcch, et Observ, sur 1» Gale, 8vo.
Paris, 1822. — Ilelmerich, Miithode pour gu<!rir la (i:ilc en
deu.v .lours, par J. Burdin, 8vo. Paris, 1822. — Plumbe, On
Dis. of the Skin, 8vo. Lond. ed., vol. ii., p. 300. — Cazenave
et Schedel, Abrtgti Pratique des Mai. de la Peau, 8vo.
Pans, 1, 'tis. — Deiheims, SuMTn. de Chun. Mfedicale, Dec,
1827. — Houghton, in Cyclop, of Pract. Med., vol. iii., p. 633.
— J. Green, Pract. Compendium of Diseases of the Skin, 8vo,
Lond., 1^35, p. 63. — P. /{oyer. Theoretical and Pract. Trea-
tise on Dis. of the Skin, trans, by R. Willis, 8vo. Lond.,
1835, p. 387. — Kemuir, in Loml. Med. Gaz., Oct., 1834, p.
29. — Raspail, M(im. coinpiratif sur I'Hist. Natiirelle de
rinsecte de la Gale, 8vo. Paris, 1834. — A. Gras, Rcch. sur
I'Acarus de la Gale de I'llome, 8vo. Pans, 1831. — Fanto-
netli, in Archives Guiicir. de Med., t. xxx., p. 407.

KIDNEYS.— The Diseases of. — 1. Our
knowledge of the diseases of the kidneys has
been recently very much advanced and render-
ed more precise by the researches of Drs.
Briohtx Prout, CnRISTIso^f, Gregory, Willis,
Osborne, Rayer, and others. In the present
article will be discussed the diseases of lohich
these organs arc the only or principal scats ; and,
in that devoted to the consideration of the urine,
those disorders in which the kidneys and other uri-
nary organs are functionally disturbed. The great
importance of an early attention to the disor-
ders, and more especially to the actual diseases
of these organs, especially in relation to several
consecutive maladies, and to various pre-exist-
ing changes of the digestive and assimilative
functions and of the circulating fluids, has be-
come very manifest since the researches of Dr.
Bright disclosed to us some of the most inter-
esting, most common, and most fatal of the
lesions to which the kidneys are liable.

2. The causes of diseases of these organs do
not, for the most part, act immediately upon
them. Intimately associated with the digestive
and assimilative viscera, through the medium
of the ganglial or organic nerves, with the cir-
culating organs by the states of the blood, and
with the cerebro-spinal nervous system, by
means of the spinal nerves communicating with
the renal ganglia and plexuses, the kidneys arc
liable to be deranged sympathetically, or indi-
rectly, during the progress of the various dis-
orders and maladies by which these important
parts of the human frame are affected. As the
chief emunctories of effoete and hurtful materi-
als, the ultimate product of assimilation, that
are liable to accumulate in, and require to be
carried out of the circulating fluids, the kidneys
are disturbed by the superabundance and pecu-
liarities of these materials. Eliminating these
various elements and substances existing in the
blood circulating through them, by means of
the nervous influence conferred on them, chiefly
by the ganglia and plexuses which supply and
endow them ; and combining these elements
into new forms, frequently of an irritating and
hurtful nature, they are liable to disorder from
causes which may diminish, excite, or other-
wise modify this influence, or interrupt the ex-
cretion of the fluid and saline matters that they
are destined to accomplish. Intimately asso-
ciated, moreover, with the other organs elimi-
nating from the circulating mass, materials of
an irritating or otherwise hurtful tendency,
they are liable to disorder, sometimes of a vi-
carious character, from causes acting upon the
organs thus associated with them in function,
although in other respects remotely connected
with them, and from diseases affecting the or-
ganization or functions of those parts : thus
are the kidneys affected by causes acting upoa

738

KIDNEYS — Inflammation of thk.

the skin, lungs, liver, digestive canal, and gen-
erative organs ; by diseases affecting the func-
tions and organization of those several viscera ;
and by morbid conditions of the system in gen-
eral, or of the nervous and vascular systems in
particular.

3. These are circumstances calculated to in-
crease the difficulty of the study of the diseases
of the kidneys ; and it should not be concealed
that there are causes which add to this diffi-
culty. Among these, the low degree of sensi-
bility with which the internal structure of these
organs is endowed ; their situation — protected
in one direction by a firm and unyielding mass
of muscles, &c., and surrounded in all the rest
by various viscera ; and the changes which
their secretion undergoes in the parts through
which it passes or accumulates, deserve due
consideration, and should impress the mind of
the physician with the importance of a diligent
investigation of the phenomena, and of caution
in forming his opinion as to the nature of the
affections referrible to these organs, as the only
guides by which the indications and the means
of cure can be safely directed.

4. It is, perhaps, owing to these causes of
difficulty that the disorders and morbid chan-
ges to which the kidneys are liable, the signs
and symptoms by which they are indicated, and
the means most efficacious in their removal,
have made so little progress until recently, and
still require, notwithstanding the advances
which have been lately made, so much farther
elucidation. In the present consideration of
the diseases of the kidneys, I shall first describe
the inflammalory diseases, and their pathological
and therapeutical relations, and afterward no-
tice the changes, chicjlij structural, consequent
upon these and upon other disordered states.
I. Inflammation of the Kidneys. — Svnon.

Nephritis. — NedpLTtc, Hipp., Galen (from Ne-
<ppog, the kidney). — Renum Injlammatio, Sen-
nert. Phlcgmone renum, Prosper Alpinus.
Cauma Nephritis, Young. Empresma Nephri-
tis, Good. Inflammation des Rei7is, Nephrite,
Fr. Nierencntziindung, entzii-ndung der Nie-
ren. Germ. Nefntico, Inflammazione di reni,
Ital.

Classif. — 1. Class; 2. Order (Cullen). 3.

Class; 2. Order (Good). III. Class, I.

Order {Author in Preface).

5. Defin. — Pain in the lumbar region, often
extending anteriorly through the abdomen, or de-
scending to the groin and testes, icith retraction of
the latter, disordered state of the urniary secretion
and excretion, febrile disturbance, sometimes numb-
ness of the thigh, and nausea or vomiting.

6. These symptoms are the most character-
istic of inflammations of the kidneys ; yet they
are not all present, unless in some of the more
acute cases, or when the inflammation extends
to the greater part of the tissues composing the
organ ; and they may be attended by various
contingent and much less constant phenomena.
In the slighter and more partial cases, particu-
larly when the disease commences insidiously
and proceeds slowly, any one, or more than
one, of these symptoms may be absent ; a dis-
ordered state of the urinary secretion and ex-
cretion being the most constant.

7. Until very recently, all the inflammatory
and painful affections of the kidneys, whatever
may have been the particular tissue affected,

were comprised and confounded under the
term nei)hri!is. Late investigations have, how-
ever, shown that inflammations differ, both as re-
spects their seats in the particular tisssues com-
posing these organs, and as regards their na-
tures, in relation to the states of the constitu-
tion, and the causes which produced them. I
shall therefore describe, 1st. The inflammations
seated in the cortical or vascular, and in the tubu-
lar structures of the organ, with the modifications,
and complications, and lesions usually presented
by them ; 2d. The inflammations seated iii the
calices and pelvis of the viscus, in connexion with
their modifications and complications ; and, 3d.
Inflammation of the investing structures of the
organ.

8. i. Inflammation of the Vascular and
Tubular Structure of the Kidneys. — Synon.
Nephritis propria, Author. — Nephrite simple,
Rayer. — Nephritis proper.

9. A. Causes. — a. The predisposing causes of
nephritis are, chiefly, hereditary conformation ;
the middle, advanced, and matured periods of
life ; the male sex, sanguine temperament, and
plethoric habit of body ; indulgence, long at a
time, in soft, warm beds ; the use of much an-
imal food, and of highly seasoned or spiced
dishes, of too much food, and fermented liquors ;
addiction to venereal pleasures ; riding much
on horseback, or in a carriage ; chronic disor-
ders of the digestive organs ; sedentary occupa-
tions, indolence, and a neglect of due exercise ;
and the superabundance of excrementitious mat-
ters in the blood, more particularly of urea and
its combinations. The calculous, gouty, rheu-
matic, and scrofulous diatheses, and diseases
of the bladder, prostate gland, and urethra,
whether these depend upon hereditary descent
or upon acquired disposition and advanced age,
especially predispose to nephritis, and modify,
more or less, the characters and course of the
disease, the varieties and complications which
result from their influence requiring a particu-
lar notice.

10. b. The exciting and concurrent causes of
nephritis are injuries, blows, contusions, con-
cussions, or wounds of the region, or in the vi-
cinity of the kidneys, or of the spine ; sudden
jerks experienced on horseback, or in a car-
riage, or occasioned by missing a step on de-
scending stairs ; falls on the back or thigh ; too
long retention of the urine ; the improper use
of irritating diuretics, of emmenagogues, or of
aphrodisiacs ; too long a course, or too large
doses of the preparations of iodine, of nitre,
&c. ; indulgence in spirituous liquors ; vene-
real or other excesses ; the presence of calcu-
li in the kidneys, or in the ureters ; calculi in,
or inflammations of, the urinary bladder ; the
sudden suppression of the perspiration, espe-
cially when inordinately increased ; sleeping in
the open air, or on the ground ; sleeping in
damp beds or sheets ; cold and moisture ap-
plied to the loins or lower extremities ; cold
and humid states of the air ; currents of cold
air striking against the loins; sitting with the
back to a hot fire ; the sudden interruption of
accustomed discharges, as the ha;morrhoids,
catamenia, fluor albus, sudor pedum, &c. ; the
retropulsion and drying up of chronic erup-
tions and old ulcers by external treatment ; the
sudden transfer of morbid action from the uri-
nary bladder, genital and sexual organs, fronj

KIDNEYS — Acute Inflammation of the.

723

Ihe psoar muscles, or from the organs of di-
gestion and respiration, or interruptions to the
healthy functions of tliose organs ; retroces-
sion or mis|»lacement of gout, metastasis of
rheumatism ; paralytic affections, diseases and
injuries of the spine or spinal column, and es-
pecially paraplegia ; fevers characterized by a
low state of the vital energies, and oppression
of the nervous functions, with coma, &c. ; the
presence of animal poisons, purulent or sanious
matters, or other hurtful excrementitial sub-
stances in the circulation, however introduced
there, whether by absorption, or from morbid
changes in the chyle or blood during the prog-
ress of other diseases.

11. From the above enumeration of the caus-
es of nephritis, it will be manifest that this dis-
ease, in some one or other of its forms, will ap-
pear, 1st. As a. primarii and simple affection, the
result of causes influencing the vascular state
of the kidney or kidneys, without any very
manifest pre-existing lesion of this or any oth-
er organ, either in function or structure ; 2. As
consecutively upon some other malady, affecting
either this particular organ, or some other, or
even the constitution generally ; as upon the
formation of calculi in the kidney itself, upon
inflammation of the bladder or testis, upon
gout, or upon disease of the prostate gland or
urethra, or during the progress of fevers ; 3.
When appearing secondarily, it may either form
the chief or only lesion, or constitute one of a
complicated state of disease, as when the neph-
ritis is complicated with gout, rheumatism,
or with other diseases of the urinary organs ;
4. Whether occurring primarily or secondanly,
it presents various grades of activity, from the
most acute to the most chronic, and gives rise
to changes which have some relation to the se-
verity and duration of the attack ; the circum-
stance of one or both kidneys being affected ;
the constitution and diathesis of the patient ;
the nature of the predisposing and exciting
causes, and of the disorders which have prece-
ded, or become associated with it, although
such relation may not be obvious, nor admit of
being traced with ease and certainty, numerous
circumstances occurring and modifying the
march and consequences of the disease.

12. B. Description. — The symptoms of neph-
ritis vary extremely, according to the severi-
ty of the attack and the particular part of the
organ inflamed ; to the circumstance of one
only, or of both kidneys being affected, and to
the mode of attack. Inflammation seizes on
either one or both organs, according to the
predisposition of the patient and the nature of
the exciting causes ; but in either case it may
appear with great severity and suddenness, or
in a mild, slight, and insidious manner; or it
may commence in this latter manner, and
quickly pass into an acute and very severe
form. On the other hand, a sudden and an
acute attack may degenerate into a very obsti-
nate and chronic form, notwithstanding the
best efforts of the physician.

13. Not only may injlammation of the vascu-
lar and tubular structures of the kidneys assume
any grade of intensity, and hence be acute, sub-
acute, or chronic, but it may also be modified in
character by the nature and combinations of its
causes ; by the diathesis, constitution, and age
of the patient ; and by the states of the circu-

lating fluids. I shall therefore cons\AGr, firstly,
its simple form, and as usually observed in a
previou.sly healthy constitution ; and, secondly
the modifications arising from those circum-
stances.

14. a. The symptoms of simple nephritis, of
primary or idiopathic nephritis, of inflammations
of the vascular and tubular structure of the
kidneys, which are independent of diathesis,
of constitutional vice, or of animal poisons,
vary with the severity of the attack, and with
the age and irritability of the patient. — a. The
acute form of the disease is generally attended,
at its invasion, with chills, horripilations, or
distinct rigours, and one or other of them oc-
casionally, sometimes daily, appear during its
course. A sense of heat, which augments
rapidly, is at first felt in one or both lumbar re-
gions. Tills soon is accompanied with pain,
at first tensitive, afterward lancinating and pul-
sating, in the same situation. The pain is at
first not aggravated by pressure from behind,
nor from before, unless it be applied firmly ;
but it is generally increased, upon a full inspi-
ration, and on coughing or sneezing, particu-
larly when pressure is made upon the abdo-
men at the same time. The pain is also mo-
mentarily aggravated by efforts to pass a cos-
tive stool, or to expel the urine, and at the time
of turning suddenly around, or from side to
side, and upon silting down, especially upon a
low seat. A very warm bed increases it, and
a chill of the surface has generally a similar
effect. The pain extends anteriorly through
the abdomen, stretching, in the course of the
ureters and spermatic vessels and nerves, to
the hypogastric region, often with extreme vio-
lence, to the testes, which are drawn closely to
the abdominal ring, and descends to the ex-
tremity of the penis, which is small and re-
tracted. Numbness is frequently felt in one or
both thighs, according as one or both kidneys
are affected ; and this feeling is sometimes ac-
companied with painful lancinations in the
thighs, descending often as low as the knee.
The pain, posteriorly, ascends as high as the
shoulder-blades ; it is increased in the region
of the kidneys, and is attended by an augment-
ed sense of heat and pain after lying for some
time on the affected side, when one kidney
only is inflamed, or on the back when both are
affected, although these positions give at first
slight ease.

15. The urine is generally passed frequently,
and with aggravation of the pain. It is at first
limpid and colourless, but is much diminished
in quantity, becomes deeper in colour, and is
voided more frequently and with more pain as
the disease increases in severity. In the most
acute cases, particularly when both kidneys
are affected, the urine is in very small quanti-
ty, is voided with the most painful efforts,
sometimes only in drops, is of a reddish, or
sanguineous, or brown colour, or with small
brownish flocculi ; and it is often nearly, if not
altogether suppressed, so that the bladder is
found empty upon the introduction of the cath-
eter. The chief changes presented by the urine
in simple nephritis are: 1st. It contains some
blood or albumen ; 2d. It is but slightly acid,
or neutral, or alkaline ; 3d. It sometimes con-
tains a little purulent matter, or muco-puriform
matter, particularly when the inflammation ex-

734

KIDNEYS — Acute Inflammation op tub.

tends to the calices or pelves of the kidneys, or
when the disease is associated with inflamma-
tion of the mucous surface of the bladder, or
of other parts of the urinary passages. Where
nephritis is caused by cantharides, turpentine,
or cold, the urine very commonly contains
blood. In the simple form of nephritis, tlie
presence of albumen in the urine is not con-
stant, as is the case in the granular disease of
the kidneys, or albummous nephritis, as it is
called by M. Rayer.

16. Soon after the accession of rigours, at the
invasion of the disease, nausea and vomiting
are often present. In the most acute states,
retching continues throughout, although no-
thing may be rejected, and is renewed after
taking fluids, so that the patient refuses every-
thing. He often complains, also, of severe col-
icky pains in the abdomen, which is sore upon
firm pressure ; particularly towards the lateral
and epigastric regions. There is generally con-
stipation, frequently with repeated desires to
go to stool, and occasionally with tenesmus ;
all these symptoms depending upon intimate
consent of parts. The pulse is hard and fre-
quent, and full during the remissions of pain ;
but in the paroxysms or accessions of pain it
is smaller and contracted. The ski7i is at first
hot, dry, or burning; but, as the disease ad-
vances, it becomes more moist, is partially and
irregularly covered by a disagreeable perspira-
tion, and, in cases characterized by a partial or
total suppression of urine, the perspiration has
a urinous odour.

17. When the disease extends to the investing
membrane of the kidneys, the symptoms are then
very acute, the pain severe, the pulse hard and
contracted, and the urine is less changed from
the natural state, relatively to the severity of
the pain and constitutional symptoms, than
when the secreting structure is chiefly affected.
But the disease is more rarely limited to one
or other structure, although either may be its
principal seat. When it commences in the se-
creting and more internal textures, or in the
calices or pelvis of the organ, the urine con-
tains much mucous or muco-puriform matter,
and is very scanty ; and the pulse is softer, the
symptoms are milder, and the course, of the dis-
ease slower than that above described, which is
seldom prolonged beyond a fortnight, frequently
not beyond six or seven days, without giving
rise to some one of the changes or lesions which
will be noticed in the sequel. When the attack
is occasioned by the irritation of calculi in the
kidney, there are commonly more numbness
of the thigh and painful retractions of the tes-
tes, and severe pains, shooting at intervals to
the hypogastrium or in the course of the ure-
ters, than in the more primary and simple states
of the disease, which states are of less frequent
occurrence than this, and of shorter duration ;
this particular cause, and the complication pro-
duced by it, being generally a chronic disease,
liable, however, to assume an acute or sub-
acute form, as will be noticed hereafter.

18. Acute and sub-acute nephritis most com-
monly implicates one kidney, both organs being
more rarely affected, especially in the same de-
gree, at the same time. While total suppres-
sion of urine may be considered as distinctive
of severe disease of both kidneys, yet both may
be inflamed, and a scanty secretion take place,

for a portion of either organ may be still ena-
bled to perform its function;?. These states of
nephritis commonly present themselves as fol-
lows : 1st. Mild acute or sub-acute: the pain in
the loins slight ; little diminution or change of
the urine ; slight symptomatic fever, and speedy
subsidence of the disease under treatment.
2d. Simple acute and sthenic nephritis : greatei
severity of the pain and of the other symptoms ;
inflammatory fever, preceded. by rigours ; mark-
ed diminution of the urine, with the morbid ap-
pearances and disorder attending the discharge
of it, described above (^ 15). 3d. Acute neph-
ritis, with ischuria, and disturbance of the cerebral
functions : suppression of urine altogether or
nearly complete ; vomitings or retchings from
the commencement ; pain in the loins, in some
cases severe, in others obscure ; lethargy, so-
por, or coma, supervening in the worst attacks.
4th. Asthenic or maligiiant acute nephritis : in-
flammation of the structure of the kidneys oc-
curring during states of cachexia, or coincident
with morbid states of the blood and depression
of vital power, or appearing in the course of
low fever or scarlatina, attended by a lurid,
dusky, and offensive odour of the surface of the
body ; little or no pain in the back or loins, un-
less firm pressure be made ; the supine posture
in a state of stupor, or sopor, the patient an-
swering questions withdifllculty and imperfect-
ly ; suppressed, scanty, or involuntary excre-
tion of urine ; frequent occurrence of slight
rigours ; the tongue dry, loaded, and brown ;
little or no thirst ; stupor, coma, and an offen-
sive odour proceeding from the surface.

19. i3. Sub-acute Nephritis. — When inflamma-
tion of the secreting structure of the kidney
takes place slowly in a mild and sub-acute form,
the patient complains of dull or shooting pains
in the lumbar region, occurring at longer or
shorter intervals, with disorder of the secretion
and excretion of urine, aggravated by errors of
diet and regimen. These symptoms are con-
nected with more or less disturbance of the
system generally, and of the functions of the
digestive organs ; frequently presenting peri-
ods of aggravation and amelioration, and occa-
sionally assuming suddenly, especially after the
operation of one or more of the causes above
enumerated {^ 10), a very acute form.

20. This state of the disease is of very
uncertain duration. Sometimes it continues,
with intermissions, for several weeks, or even
months, when it may assume a very acute or
hyper-acute form, or may subside into a less se-
vere and more chrojiic state.

21. When sub-acute nephritis passes into a
hyper-acute state, the disease may reach its ut-
most severity in two or three days, and if cir-
cumstances favour its continuance, or insuffi-
cient means be adopted to subdue it, the symp-
toms assume, in one, two, three, or lour days
more, the most dangerous character. The pain
becomes sometimes insupportable ; the pulse
small, contracted, unequal, or intermittent, fre-
quently slow ; the extremities become cold, or
arc kept warm with difficulty ; the countenance
assumes a leaden or murky hue, and the fea-
tures are otherwise much changed ; hiccough
supervenes, and a cold, foetid, or urinous per-
spiration covers the surface of the body. The
urine, if any be voided, is usually now very
dark-coloured, filamentous, passed drop by drop,

KIDNEYS — Chronic Inflammation of the.

725

and of a cadaverous odour. The muscular
force sinks rapidly : fainting delirium, convul-
sions, stupor, and coma supervene, and the pa-
tient dies.

22. y. Chronic Ncpkruis. — Inflammation of
the substance of the kidney may exist in either
ihe acute or sub-acute form, and gradually lapse
into the chronic state. Or, inflammatory action
may commence in a slight and mild form, pro-
ceed gradually and insidiously, and he so ob-
scure as not to awaken the fears of the patient,
and as to escape the observation or detection
of the physician. In these cases, pain, if at
all present, is often slight or obscure ; disorder
of the quantity and states of the urine ; a dim-
inution of acidity, and a neutral or alkaline
state of it ; disorder connected with the evac-
uation of it ; a feeling of weakness or of slight
Duml)uess in one or both lower extremities, are
the symptoms most commonly observed. The
urine is generally turbid, occasionally only al-
buminous, generally abounding with the phos-
phalic salts and with mucus, and often depos-
iting sediments, or containing more or less of
gravelly matters. It is always voided frequent-
ly, but in very small quantity at a time. Pain
in the loins is often not felt unless on firm pres-
sure, and on taking a full inspiration. It some-
times extends in the course of the ureters, but
seldom to the testes. When it is not associa-
ted with disease of the bladder or prostate,
there generally is little or no fever, unless at
night, or when the patient is heated by a warm
bed. This state of nephritis is often excited
or perpetuated by disease of the urethra, or
prostate gland, or urinary bladder. In some
cases this form of the disease approaches a suc-
cession of slight attacks of acute or subacute
inflammation, each subsiding for a time or re-
turning, or affecting circumscribed portions of
the organ. When both kidneys are affected,
the chief symptom may be the gradual deterio-
ration of the constitution, and development of
cachexia, favouring the occurrence of other
maladies, especially dropsy.

23. Many of the organic lesions found in the
kidneys upon dissection, as well as the forma-
tion of calculi in the organ, proceed from this
slight and slow state of inflammatory action of
its secreting structure ; and, whether passing
into more active forms of disease, or giving
rise to suppuration, it frequently renders the
future life of the patient irksome, especially
when afl^ecling old persons, even without pro-
ducing the latter effect ; but when it occasions
this, the patient, particularly if he be advanced
in life, but rarely escapes. The chronic as
well as the acute forms of inflammation gen-
erally attack one kidney only, and more rarely
both at the same time, or in the same degree ;
hence the urine is very rarely suppressed, al-
though it is often much diminished in quantity.
RicHTKR (Thcrapeia Specialis, t. i., p. 534) says
that the left kidney is more frequently inflamed
than the right ; and a similar opinion has been
stated by other pathologists ; but this is not
satisfactorily proved.

24. 6. Nephritis in the female is a less fre-
quent and less dangerous disease than in the
male, but it is often more difficult of detection,
in its chronic forms especially ; and it is liable to
be mistaken for affections of the uterine organs,
with which, also, it is occasionally complicated.

The existence of pain in the lumbar region ex-
tending to the abdomen, and shooting towards
the bladder and groin, with numbness of the
thigh and disorder of the secretion and excre-
tion of the urine, arc, however, sufficient to
prove the existence of nephritis in this class
of patients. Two cases of the disease in fe-
males have come before me which had been
mistaken for disease of the colon, and one for
inflammation of the bowels. This want of
knowledge of so very important a disease has
evidently arisen from the very slight attention
paid to diseases of the kidneys by systematic
writers, and to the careless way in which the
urinary secretion is examined by too many
practitioners. Nephritis is not infrequent among
females recently confined, but is then com-
monly associated with inflammation of the
veins of the uterus and ovaria, or with peri-
tonitis.

25. C. Termin.itions, &lc. — a. When reso-
lution takes place, the severe symptoms abate
from about the fourth to the ninth day, in the
more acute cases ; and, in the sub-acute, fre-
quently not until the twelfth or fifteenth of the
attack. When this change occurs, the urine
becomes more abundant, paler, is voided with
less uneasiness, and deposites a sediment ; the
pulse becomes more natural ; occasionally full-
er, softer, and even quicker than previously,
especially if it have been slower during the
acute state ; a general perspiration breaks out,
and critical discharges, particularly the haemor-
rhoidal and catamenial, sometimes appear, es-
pecially when the disease has arisen from sup-
pression of these evacuations. In some cases,
particularly in persons advancing in age, reso-
lution is imperfect, the urine continuing scanty
and albuminous, other symptoms remaining in
a slight form. In these there is reason to sus-
pect that slight depositions of coagulable lymph
iiave taken place, during the acute state of the
disease, in the tissues composing the body of
the organ, and are giving rise to granular de-
generation.

26. b. Suppuration or abscess does not so
often occur during inflammation of the vascu-
lar and tubular structure of the kidney as is
supposed. The presence of purulent or muco-
puriform matter in the urine is no proof of sup-
puration of these parts, but merely shows that
the inflammation has extended to the calices
and pelvis of the organ. Abscess of the kidney
may be the consequence of inflammation, either
unconnected with, or depending upon calculi in
the tubular structure. It may also proceed
from slight, or chronic, or sub-acute inflammation
in scrofulous subjects, and more commonly it
is in them unconnected with calculi, and as-
sumes a more chronic character. If the very
acute form of nephritis continue, without ma-
terial alleviation, beyond seven or eight days,
or the sub-acute persist longer than fifteen
days, the formation of matter may be dreaded,
especially if, about this lime, several of the
following symptoms appear; when the disease
passes from an acute into a more chronic state,
or milder character, the pain and heat being
abated, but still continuing ; when the pain be-
comes dull and pulsating, with a sense of
weight or embarrassment in the lumbar re-
gion, and increased numbness of the thigh cor-
responding with the organ afliectcd ; when rig-

726

KIDNEYS — Inflammation of the — Terminations.

ours occur irregularly or at different hours of
the day ; and when perspirations become fre-
quent and copious, the pulse small, weak, and
soft, the symptomatic fever assuming an ady-
namic, and subsequently a typhoid character,
cerebral symptoms supervening, we may then
conclude that an abscess has formed in the
structure of the kidney.

27. In the more chronic or sub-acute cases ter-
minating in abscess, an oedematous fulness or
swelling, without change of colour, is some-
times observed. In several instances, firm
pressure of the lumbar region occasions acute
pain, extending to the groin ; and the urine
contains either blood or gravelly matter, or a
whitish purulent matter more or less intimate-
ly mixed with it, and rendering it thick and
turbid. In these more chronic states, the con-
stitutional symptoms are nearly those of hectic
fever. The symptoms may truly indicate the
existence of abscess, and yet no pus be seen
in the urine, which may even remain clear.
But, after a considerable time, the matter finds
its way into the pelvis of the kidney, and a large
quantity of pus, with some blood, is evacuated
with the urine, often occasioning, by its acri-
mony, much irritation of the bladder and ure-
thra. In other cases, little or no pus is evac-
uated in the urine, owing to the passage along
the ureter being obstructed, either at the pel-
vis of the kidney, or in some part of the ure-
ter, by a large calculus, which most probably
induced the inflammatory action giving rise to
abscess, and which now prevents the passage,
not only of the matter, but also of the urine to
the bladder. In some of these cases, the ab-
scess points externally in the back or loins, or
even in the side or above the groin, the patient
either sinking under the affection, or partially
or altogether recovering. The abscess may
burst internally into the peritoneal cavity, and
it then proves quickly fatal ; or it may open
into the colon, and the patient either recover
or sink. Of these occurrences, numerous in-
stances are recorded in the works contained in
the Bibliography to this article.

28. In the greater number of cases of ab-
scess, " the ureter remains more or less pervi-
ous, and the patient continues at intervals to
discharge pus, and sometimes small calculi,
blood, &c., with the urine for a long time"
(Prout). When the abscess opens externally,
the aperture continues for a considerable time
to evacuate purulentmatterof an urinous odour,
or pus mixed with urine, and sometimes urine
only. When the abscess discharges pus mere-
ly without any urinous odour, or without any
intermixture of urine at any period of the dis-
charge, it is then very doubtful whether the ab-
scess is connected with the kidney or no. It
may proceed from caries of one of the verte-
brae, from which it is necessary to distinguish
the abscess now under consideration.

29. When the fistulous opening, leading from
an abscess of the kidney, becomes obstructed,
either by granulations or by a calculus, the dis-
charge ceases, and a pulsatory pain generally
returns in the lumbar region, followed by in-
creased heat of skin, accelerated pulse, or even
delirium, which continue or increase until the
obstruction gives way before the accumulated
matter. When at last the external opening
heals up, without the immediate return of the

previous dangerous symptoms, a relapse may
take place at a more remote period, owing to
the return of the inflammation, probably again
induced by a calculus formed in the kidney. In
the majority of cases, especially in the ear-
lier stages of abscess, one kidney is only af-
fected ; but this may be altogether destroyed
by it. In protracted cases, particularly in aged
persons, the other kidney generally participates
in the disease, to a greater or less extent, be-
fore the one first attacked is altogether disor-
ganized. Although suppuration is a conse-
quence of inflammation, whether unconnected
or complicated with calculi in the kidney, yet
the origin of the calculi is a matter of impor-
tance. It is very probable that they may be a
result of slow inflammatory action of the tubu-
lar structure, and that, when they are formed,
they heighten this action, and give rise to sup-
puration. (See Ukine, &c.)

30. When the chronic states of nephritis oc-
cur in scrofulous persons, abscess often results,
even independently of calculi, with which, how-
ever, the abscess may be associated. When
abscess takes place in the strumous diathesis,
the symptoms attending its formation and mat-
uration are much more obscure than in other
constitutions, and the disorganization of the
kidney generally is more complete. In the lat-
ter stages of the disease, and in the more chron-
ic cases, Mr. Howship has remarked that the
patient refers his complaints more to the neck
of the bladder than to the region of the kidney ;
but in recent cases this is not so generally ob-
served. Dr. Prout has met with instances
where the pain referred to the lumbar region,
as in ordinary cases, and the urine was acid,
and, abstracting the pus, not very unnatural.
I agree with Dr. Prout in imputing the suffer-
ings in the bladder, in the more chronic cases
of this form of abscess, to the exceedingly foe-
tid, acrid, and unnatural state of the urine,
which is usually alkaline, and evidently of so
irritating a nature as probably not to be retain-
ed in a healthy bladder for a moment, without
producing great pain. Mr. Howship, however,
mentions instances of this form of the disease
where the urine appeared natural, and yet the
pain was referred to the bladder, nevertheless.
But there was very probably, in these cases,
disease of the prostate gland, or inflammation
of the parts in its vicinity, or of those adjoin-
ing the openings of the ureters, complicated with
the disease of the kidney ; for I have observed
such complications in cases which occurred in
my practice, where the symptoms were chiefly
referred to the bladder, and yet the urine seem-
ed nearly natural. Dr. Prout remarks, that
the cases of this scrofulous affection of the kid-
neys that he has seen have also been attended
with indolent tumour and abscess of the ingui-
nal glands, and by occasional pain and swelling
in the testicles. They were accompanied by
great extenuation of the body, and derangement
of the general health ; and in all instances ulti-
mately proved fatal. {On Diseases of the Uri-
nary Organs, p. 216.)

31. c. The termination of nephritis in gan-
grene is very rare ; the change actually taking
place, and often mistaken for gangrene, as some-
times approaching this state, is softc7nng, more
or less marked, of portions of the inflamed tis-
sues, with purulent infiltration, in a greater or

KIDNEYS — Inflammation of the — Lesions from.

727

less number of points. If gangrene take place,
it is indicated by the symptoms usually attend-
ing it in other organs, especially by sudden
sinking of the vital powers, and cessation of
pain ; singultus, vomitings, anxiety, restless-
ness, coldness of the surface and extremities;
small, thready, and weak pulse ; wanderings of
the intellects, and delirium. The urine also
becomes altogether suppressed, or remarkably
scanty and faUid.

32. d. Some degree of either induration or
softening may follow acute nephritis, particu-
larly the former ; and the patient may cither
apparently recover, or the disease may assume
a chronic form. Some degree of induration of
the substance of the organ consequent on the
acute state of the disease may not be incon-
sistent with the discharge, to some extent, of
its functions ; and when one organ only is af-
fected, the urine may not be materially altered,
or even not at all diminished. In these cases,
the quantity secreted by the indurated organ
cannot be ascertained, as the function of the
healthy kidney is increased. The albuminous
state of the urine in these cases seems to indi-
cate that the indurated kidney still performs
some part of its functions.

33. D. Changes OBSERVED AFTER DE.\TH /rom
inflammation of the vasadar and tubular structure
of the Kidney. — a. At an early stage of the acute
form of the disease, the volume of a part, or of
the whole of the organ, according as the affec-
tion is general or partial, is more or less in-
creased. In a few cases the kidney may be in-
creased to twice, or even thrice its natural bulk.
At this period, and before the parts inflamed be-
come infiltrated with pus, they present a morbid-
ly red tint., generally a deep or dark red, and some-
times a brownish ecchymosed appearance. The
vessels of the cortical structure, and the more
superficial veins, are enlarged and more than usu-
ally distinct. Besides these, M. Raver remarks,
that a number of small points of a lively red, not
elevated above the surface, may be seen with
the unassisted eye in the exterior of the organ.
These small red points are also found in the
first stage of ganular disease, or inflammation
of the kidney — of the nephrite albumincuse of
this writer — and are often intermingled with
black points and with small vesicles. These
latter points are often surrounded by a very
delicate network of vessels. On division, the
vascular or cortical tissue of the inflamed kid-
ney presents a similar congeries of red points,
distinct from the orifices of divided vessels ;
these points are disposed in lines or series,
very rarely in groups, and are the glandules of
Malpighi — the corpora Malpighiana — highly in-
jected. Sometimes these glandules, especially
at the exterior of the organ, assume the appear-
ance of dark or black spots, either isolated and
distinct, or approaching each other in a series,
or in groups. The surface of the organ, also,
presents an irregularly red tint, with scattered
spots of a livelier red than that of the surround-
ing tissue. The substance inflamed is, more-
over, dotted with true ecchymoses, disposed
either in lines or in bands, which probably be-
come the bases of the purulent infiltrations ob-
served at a farther advanced stage.

34. When the acutely inflamed kidney is
augmented in volume and weight, it often, also,
presents a red induration of the vascular and

tubular tissues. This induration and redness
are commonly general as respects both these
tissues ; and the glandules of Malpighi are
also highly injected and very apparent. Upon
pressing the divided parts of an indurated, red-
dish brown kidney between tlie fingers, a lar-
ger quantity of blood escapes than in the healthy
state ; but not with that facility observed in the
passive congestions of the organ consequent
upon intercepted circulation through the right
side of the heart.

35. In some states of simple acute nephritis,
M. Haver has observed portions of the organ
in a state of ana;mia interspersed between
other parts which are morbidly red, and ecchy-
mosed, or infiltrated with pus. This associa-
tion of ana;mia of some portions of the kidney
with inflammatory injection, &c., of other por-
tions, i^ also often found in cases of chronic
nephritis which have passed into the acute
form previously to death.

36. Purulent infiltration is more frequently
remarked in the vascular than in the tubular
tissue of the organ ; the former portion being
more commonly and severely inflamed than the
other. The infiltrated pus appears in the form
of grains of white sand, or of minute depots
of the size of pins' heads, surrounded by a
brownish red tissue. In some cases, the puru-
lent formations are much larger, although less
numerous, being of the size of pustules, or of
small peas, and, in rare instances, as large as
nuts. It is comparatively rare to find abscess-
es, or purulent collections, in the substance
of the kidney larger than these, most of the
cases of- large abscesses in this organ being
purulent collections of the calices and pelvis
consequent upon inflammation of these parts,
and obstruction of the ureter. These collec-
tions are surrounded by a deeper redness than
that of the adjoining parts, even when the
whole of the organ is inflamed. The small ab-
scesses, seen at the surface of the kidney, pen-
etrate more or less deeply into its substance,
and often infiltrate the tissue immediately
around them, so that drops of pus may be
squeezed from it by the point of the scalpel.
Some parts of the organ are softened and infil-
trated with pus, and are of a yellowish white
colour, drops of pus being squeezed from them
when divided ; these have not yet proceeded to
the state just described, or are merely in the
course of passing into that of small abscesses;
they are met with in the vascular as well as in
the tubular structure. Gangrenous softening is
very rarely observed in these structures, and is
characterized by its brownish hue, by their to-
mentose aspect when they are plunged in wa-
ter, and by the odour exhaled by them.

37. b. The chronic forms of nephritis present
various changes, some of which are very oppo-
site in their natures. When the whole of the
organ has been chronically inflamed, atrophy o{
it is much more frequently observed than hy-
pertrophy, which also occurs. In some instan-
ces, the vascular tissue of the organ presents a
species of hypertrophy occasioned by a deposi-
tion on it of lymph, which has assumed subse-
quently a fribro-cellular character. In others,
patches of a yellowish colour are seen exterior-
ly, and are found to consist of a soLnevvhal sim-
ilar substance, manifestly produced from coag-
ulable lymph long previously thrown out. Af-

72d

KIDNEYS — Inflammation of the — Diagnosis.

ter the clironic states of inflammation, the sub-
stance of the organ is more or less indurated,
denser, and specifically heavier than natural.
The external surface is often granulated, or ru-
gous, or it presents a variously-coloured, or
marbled appearance. Deep redness is seldom
observed, unless an acute state of inflamma-
tion has supervened on the chronic shortly be-
fore death, and then it is seen both on the sur-
face and more or less through the substance of
the organ. An anaemic condition, either par-
tial or general, and commonly associated with
induration or increased density of the textures,
is one of the most frequent lesions produced by
chronic simple nephritis ; and is generally far-
ther associated with a granulated and marbled
state of the surface, and with atrophy. This
ana;mic state commences in the vascular tis-
sue, and extends to the tubular texture, both
of which may become ultimately pale, indura-
ted, and atrophied in a very remarkable man-
ner. When atrophy takes place in several dis-
tinct points or parts of the organ, the external
surface often presents an unequal, rugous, or
mammalated appearance. The papillcz of the
cones or tubular structure undergo various
changes consequent upon their induration.
Sometimes the cones are very acute, and of a
whitish yellow colour. The papilla; are occa-
sionally eroded or infiltrated with pus, more
rarely they are ulcerated.

38. c. The membranes external to the organ
often participate in the inflammation of the
more internal textures, and present the usual
consequences of this participation, especially
vascular injection, exudation of coagulable
lymph, and, in the chronic cases, thickening of
the membranes and increased adhesions of
them over the parts inflamed. In some cases
they also experience various changes of colour,
chiefly of a brownish or blackish hue ; and oc-
casionally they are changed, in places, to fibrous,
fibro-carlilagincHis, or even to a cartilaginous
or osseous state. Besides these lesions, oth-
ers hereafter to be described take place as a
consequence of inflammation, and various in-
flammatory changes are also observed in the
calices and pelvis of the organ. The veins of
the kidneys are sometimes inflamed, but inde-
pendently of this form of nephritis. Renal
phlebitis is more frequently associated with
granular degeneration of the kidneys or albu-
minous nephritis.

39. E. Diagnosis of the simple states of
Nephritis. — a. The distinctions between these
and the other forms of nephritis will be made
more manifest when the latter come under
consideration. I shall, therefore, merely re-
mark very briefly that, in the gouty variety of
nephritis, the urine deposites crystals of uric
acid, which are never observed in the simple
form of the disease ; and that the granular de-
generation of the kidney is always either ac-
companied with or followed by dropsy, and
characterized by a constant and marked albu-
minous state of the urine, this latter change
being only accidental and evanescent, although
sometimes recurring in the simple forms of
nephritis. The inflammation of the sul)stance
of the kidneys, occurring in the course of low
and exanthematous fevers, arises from the mor-
bid poison in the blood, or, rather, from the ac-
cumulation of excrementitial matters, and the

consequent alterations in this fluid in connex-
ion with the state of organic nervous power;
and, from being thus a consecutive disease,
and attended by certain features hereafter to be
noticed, cannot be confounded with the prima-
ry and simple nephritis just described.

40. h. It is often impossible to distinguish
the acute form of simple nephritis from inflam-
mation of the intesting membranes of the kid-
neys, on the one hand, or from inflammation of
the pelves and calices of these organs, on the
other ; because the disease is seldom limited
altogether to either of these structures, al-
though it be seated in one or other chiefly.
When the urine contains much mucus, or a
muco-puriform matter, the urethra and urinary
bladder being sound, then the morbid secretion
can proceed only from the pelves and ureters.
But, in these cases, it is almost impossible to
say that the bladder is healthy. However,
when inflammation of the pelves and calices is
so severe as to produce an abundant secretion
of mucus, it is very rare that the substance of
the kidney does not participate in the inflam-
mation. When, in addition to this secretion,
there is severe pain felt in the loins, attended
by vomiting and other acute symptoms, it may
be inferred that the disease extends to both the
substance and the pelves of the organ. It ia
much more difficult to distinguish the chronic
states of inflammation of the substance from those
of the pelvis of the kidney, even although the
morbid action be confined to either structure ;
but such limitation often does not exist, both
parts being implicated, although one or other is
more especially affected. Still, in the simple
chronic nephritis, the quantity of muco-puriform
matter in the urine is much less than when the
calices and pelves are chronically inflamed, and
the phosphates are more frequently found in
suspension. Most of the cases usually denom-
inated abscess of the kidney are nothing more
than accumulations of pus in the pelvis, owing
to the obstruction caused by a calculus distend-
ing it and the surrounding parts, and transform-
ing the organ into a large multiiocular tumour
containing puriform matter. When the inflanrt-
mation is seated chiefly in the calices and pel-
vis of the organ, and especially when it is
caused and perpetuated by calculi, then more
irritation is felt in the bladder, especially about
its neck, and more pain in the course of the
urethra, than in other cases. The irritability
of the bladder is so'rnetimes so great in these
cases as to almost amount to incontinence of
urine.

41. c. Inflammation of the surrounding cellular
tissue, or of the investing membranes of the kid-
neys, very closely resemble acute nephritis ;
but there are not such remarkable changes in
the quantity and character of the urine, or such
disorder connected with the excretion of it,
correspondent with the acuteness of the local
and constitutional symptoms, as are observed
in true nephritis. When the membranes espe-
cially are inflamed, the sense of heat and the
pain are very great, while the diminution of
urine and the difficulty of excreting are not
so remarkable. When the surrounding cellular
tissue suppurates, and a considerable abscess is
formed, the lumbar region becomes full and dis-
tinctly (Edematous, and ultimately even fluctu-
ation may be detected. Inflammation of the

KIDNEYS — Inklammation of the— Modified states op.

729

ctUuIar tixsuc surrounding the psoas muscle — pso-
itis, or the commencement of lumbar abscess —
may be mistaken for nephritis ; bnt in the for-
mer disease tlie pain is much increased upon
flexure of the thigh upon tlie trunk, while the
secretion and evacuation of urine are either
not disordered or hut slightly disturbed.

42. d. Nephritis is distinguished from the
simple irritation consequent upon the passage
of a calculus along the ureter, chiefly by the fever
which accompanies the pain of nephritis from
its commencement, and by the pain never be-
ing altogether absent, although it is generally
characterized by remissions and exacerbations.
Nephritis can hardly be confounded with ne-
phralgia: this latter affection is very rare ; the
pains constituting it are much more violent
than those of nephritis, are sudden in their ac-
cession and disappearance, and are unattended
by fever or heat of skin.

43. e. From acute rheumatism nephritis will
be readily distinguished by the nausea, vomit-
ing, colicky pains in the abdomen, the numb-
ness of the thigh, the extension of the pain to
the hypogastrium and groins, and to the testes,
with retraction of them to the abdominal ring,
and the disorder of the secretion and excretion
of urine which characterize the latter disease,
but which do not attend the former unless
rheumatism attacks or extends to the invest-
ing membranes of the kidneys, as will be more
particularly noticed hereafter. Lumbago can
hardly be mistaken for nephritis, as, besides
the absence of the above symptoms in the for-
mer disease, it is seldom attended by any feb-
rile action ; and the pain on bending the back,
upon rising from a seat, or exerting the dorsal
muscles, is distinctive of the rheumatic nature
of the affection.

44. /. In females, nephritis is often distin-
guished with difficulty from colic, from inflam-
mation of the psoaj muscles, from enteritis,
from obstruction and inflammation of the colon,
and from inflammation of the internal iliac vein
or artery. Numbness of the thigh, pain in the
lumbar region, extending in the course of the
ureters to the groins, insides of the thighs, and
urinary bladder, and being referred more to the
posterior regions of the abdomen than to its
anterior aspect, with absence of tenderness
upon slight pressure, and the disorder of the
secretion and excretion of urine, are generally
sufficient to mark the nature of the disease.

45. g. It is often more difficult to distinguish
nephritis from uro-cystitis than is generally sup-
posed. It should, however, be recollected that
both diseases are often associated ; and that
both simple nephritis and inflammation of the
pelvis of the organ, caused by the irritation of
a calculus, may be attended by more severe
symptoms referred to the bladder and urethra
than those felt in the lumbar region ; while uro-
cystitis may be attended by pain in the loins,
and various other symptoms of nephritis. The
great irritability of the bladder, the appearance
of the urine, the pain behind the pubis, and the
absence of numbness of the thigh, or of pain
and retraction of the testes, unless when the
kidneys are also affected, will generally indi-
cate the seat of the disease. But this subject
will be noticed more particularly hereafter.

46. ii. MoDiFiF.D St.ates of Nephritis. — In-
flammation of the kidneys presents various

11 92

modifications or varieties proceeding from the
diathesis of the patient, and the nature of the
exciting causes.

47. A. Of Gouty Nephritis — of Nephritis in the
Gouty Diathesis. The fact of gout attacking
the kidneys was first remarked l)y Aruta-.vs,
and more particularly by Wepfer, Specht,
Sydenham, Bonet, F. Hoffman.v, Moroaoni,
De IIae.\, Stoll, Van Swieten, Chopart, and
by other practical writers of the last century.
Modern authors, especially Bartiiez, Home,
GuiLUERT, Prout, Scudamork, Brodie, R.iver,
and others, have farther shown that inflamma-
tions of the kidneys, either with or without
gravelly and calculous formations, but most
frequently in connexion with them, are very
liable to occur in gouty constitutions, or in
connexion with gouty attacks, and to assume
peculiar features.

48. a. Symptoms. — These vary remarkably,
according as the inflammation is associated
with uric acid gravel in the vascular and tubu-
lar structure, or with calculi in the pelvis or
other parts of the organ, or with disease of the
bladder or prostate gland. Gravel or some
calculi may exist long in the substance of the
kidney, without any of the symptoms of disease
of the organ being felt, or, at least, felt so as to
attract particular notice. It is only when these
produce irritation, or when various circum-
stances occasion vascular determination or
congestion of the kidneys, or when a calculus
is arrested in the ureters, that indications of
disorder in this quarter present themselves.
In these cases, the disease assumes features
more particularly noticed in the article Urine,
and gives rise to those painful affections usual-
ly called nephritic colic. When these painful
attacks occur in a gouty person, and are ac-
companied by a frequent desire, especially du-
ring the night, to pass the urine, this fluid
containing more or less albumen, and blood-
globules, with acid, they probably depend upon
calculi in the pelvis of the kidney, or in the
ureter ; and this will be still more probably the
case, if the pain exist in, or extend to the lum-
bar region, and is attended by great irritability
of the bladder, by incontinence of the urine, by
pain about the neck of the bladder and in the
urethra, and by uneasiness, numbness, &.c., in
the thigh, testes, &c. Whenever the urine of
a gouty person presents crystals of uric acid,
sometimes with a little blood, or mucus, or
mnco-puriform matter, then the existence of
calculi or gravel in the kidney may be suspect-
ed, although the symptoms referable to this
organ itself may not be very severe or well
marked. When these morbid states of the
urine are more decidedly characterized, the
existence of calculi may be inferred with much
certainty, and is often proved by their escape
with the urine at no very distant period. When
calculi do not exist in the kidneys, pains in the
lumbar region are not constant, or are merely
passing. The circumstances, however, whicli
more especially distinguish gouty nephritis are
the occurrence of the inflammation in the gouty
habit, and in connexion with gravel and calcu-
li ; the very acid state of the urine, which im-
mediately presents or deposiles crystals of uric
acid, and the antecedent and attendant symp-
toms of gout in the system. On the other
hand, in simple nephritis, the urine is most fre-

730

KIDNEYS — Inflammation of the — Modified states of.

quently neutral or alkaline, deposites an amor-
phous sediment, usually composed of the phos-
phate of lime, or of the urates, or of the am-
moniaco-magncsian phosphate. In proportion
to the acuteness of the attack, to the diminu-
tion and other changes of the urine, and to the
predominance of the symptoms more strictly
referable to the kidneys and bladder, is the
constitutional or febrile disturbance usually
great. When the urine is suppressed or nearly
so, bloody, remarkably scanty, or very dark-
coloured, and the pains in the loins, &c., and
the attendant fever severe, either inflammation,
or extremely active congestion of the vascular
and tubular structure, or obstruction of the pel-
vis at the commencement of the ureters of both
kidneys, has taken place. When this attack
occurs somewhat suddenly, or upon the pre-
mature disappearance of gout from the lower
extremities, or after the usual premonitory in-
dications of gout, if it appear either as sup-
pressed, or metastatic, or misplaced gout, then
acute inflammation, or very active congestion
of the substance of the kidneys, may be inferred
to exist. I have lately treated a case of gouty
nephritis, in which the urine was of a black,
inky tint, and remarkably scanty ; this colour
having arisen from the action of the acid in the
arine upon the blood exhaled from the inflamed
organ.

49. b. On dissection of fatal cases of g-ouhj neph-
ritis, numerous particles of crystallized uric
acid may be detected at the surface, or in the
substance of the vascular structure of the kid-
ney. This substance is generally more or less
Intiamed in parts, and altered in structure, as
already described when stating the lesions pro-
duced by simple chronic nephritis (§ 36). Grav-
el or small calculi are also found in the papil-
lary structures, in the calices, and in the pelvis
of the organ ; those in the latter situations be-
ing comiBonly larger than those found in the
tubuli. The investing membranes of the kid-
ney are rarely materially altered.

50. B. Of Rheumatic Nephritis. — a. The occur-
rence of nepliritis in connexion with rheuma-
tism in ditferent parts of the body has been
noticed by several writers ; and, in very recent
times, also in connexion with rheumatic peri-
carditis and endocarditis, or antecedently or
subsequently to these diseases. I have seen
nephritis supervene upon rheumatism of the
lower extremities, and upon rheumatism of the
testes after sleeping in a dainp bed; and I
have observed in a female rheumatism of the
limbs, of the ovaria, and of the kidneys, nearly
contemporaneous, owing to the same cause, the
affection, however, of the former parts subsi-
ding as that of the latter became more promi-
nently developed. This variety of nephritis is
generally very obscure. Pains in one or both
loins, in the limb of the same side, and in the
testes, are very equivocal symptoms, particu-
larly in a rheumatic subject, as they may be
either simply rheumatic, or symptomatic of in-
flammation of the kidneys ; but when they are
attended by ischuria, or by a very marked dim-
inution of the urine, while there is not a very
copious perspiration, and by an albuminous and
acid state of the urine, which is voided fre-
quently, and in small quantity, with increase
of pain, and which is either very deep coloured,
or deposites a rose-coloured sediment, it be-

comes probable that the kidneys are actively
congested or inflamed.

51. b. It is not infrequent to find extensive
organic changes in the kidneys of persons who
have died of diseases of the heart, consequent
upon rheumatism ; and who have recently, or
at no very remote period, complained of disor-
der of the urinary /functions or organs. These
lesions have consisted chiefly of the infiltration
of coagulable lymph, at several points of the
vascular structure of the kidneys. These near-
ly solid deposites have given rise to marked,
unequal prominences on the external surface
of the organ, where they appear as yellowish
patches. These deposites of^ lymph are of va-
rious sizes ; sometimes sinking deeply into the
vascular structure, and approaching nearly the
size of a nut or bean. Their limits are dis-
tinctly marked by a dark reddish tint of the
surrounding tissue. The membranes external
to the kidneys, particularly the portions of them
corresponding with the deposites of lymph, are
generally injected ; the calices and pelves are
also inflamed, presenting numerous vascular
arborizations and red points. Small collections
of pus are sometimes observed in the vascular
and tubular structures ; and the organ is gen-
erally increased in weight and volume, and oc-
casionally, also, more or less indurated. In
the more chrome cases of this variety of nephri-
tis, or when the nephritic disorder has preceded
dissolution a considerable time, eminences and
irregularities of the external surface of the or-
gan are observed ; and wliat had manifestly
been, in the acute stage, deposites of coagula-
ble lymph, are now changed into a firm yellow-
ish substance, of the consistence of condensed
cellular tissue. In the pits or depressions on
the external surface, (he fibrous and cellular
membranes of the kidneys are so firmly united
with each other, and with the subjacent corti-
cal substance, as not to be separated unless
with the greatest difficulty. These membranes
are sometimes thickened throughout, but much
more frequently only in patches or partially,
where they are also much more opaque. Sim-
ple serous cysts are occasionally found in the
vascular and cartilaginous bodies in the tubu-
lar structure.

52. C. Consecutive Nephritis — Symptomatic or
Secondary Nephritis — Asthenic Nephritis. — In-
flammation principally of the vascular and tubu-
lar structures of the kidneys often arise in the
course of febrile and exanthematous maladies,
especially those which assume an adynamic or
malignant form, or in which the blood becomes
more or less contaminated. In many of these
cases, it is a state of active congestion of the or-
gan rather than that of inflammatory action
which takes plane : or if it be the latter, it is
inflammation of the asthenic kind, described in
the article Inflammation (^ 54, ct seg.), and is
produced by the morbid slate of the blood, or
by the superabundance in it of those injurious
elements or materials which require elimina-
tion from it, and which are usually excreted by
the kidneys. M. Ravkr has described these
consecutive diseases of the kidneys under the
head of nephritis from morlnd poisons ; but the
aflection of these organs is merely an accident
or contingency occasionally occurring in the
course of certain contaminating maladies, or
rarely only in the course of others, and as fre-

KIDNEYS — Consecutive Inflammation of the.

731

■quently takes place during paraplegic diseases
or after injuries of the spine, as during the
progress of tliose maladies.

53. a. During the continuance o( adynamic or
typhoid fevers, and particularly when tiie ner-
vous manifestations are prostrated or de-
pressed, and where the blood becomes altered
either by the accumulation in it of excremen-
titious matters, or from the insufficient supply
of salutary elements, congestion, or asthenic
inflammation, not infrcijuently occurs in the
kidneys. In these circumstances both organs
are generally affected. The pain in the loins
commonly complained of during fevers, and at-
tributed to other causes than to inflammation,
or to congestion of the kidneys, often misleads
the physician, and, when really proceeding from
the vascular condition of these organs, is not
generally ascribed to it. In other cases the
sensibility is so much impaired before this af-
fection supervenes, that the state of the urine
itself, and the phenomena attending its evacu-
ation, are the chief indications of its existence.
In these especially, the suppression of the urine
may be the lirst indication of it ; and then it
may be difficult to determine whether or not
the suppression be the cause or the conscqueiiee
of the inflammation ; for it may be either. The
circumstance of its so being recognised by the
physician will generally enable him to infer
correctly the alternative ; if the suppression of
urine has been preceded or attended by sopor
or coma, or by the supine posture and partial
loss of sensibility, the inflammation of the kid-
neys probably has been consequent upon or ag-
gravated by it ; the suppression being the con-
sequence of congcsiion, which may pass into
asthenic inflammation ; but if this state of the
urinary function has preceded sopor or insen-
sibility, or is independent of this state of the
nervous manifestations, then is it the conse-
quence of inflammation of the kidneys, and not
the cause. It is extremely rare, however, for
the suppression or the non-secretion of urine to
precede those states of disease ; more general-
ly the urine is secreted, its retention or accumu-
lation in its existing morbid condition being the
cause of the affection of the kidneys. In all
cases of fever, when the urine is retained in
the bladder for some time, or when this viscus
becomes distended hy it, the supervention of
nephritis should be suspected. Whenever, in
the course of low fevers, the urine is remarka-*
bly scanty, or of a dark-brown colour -, when it
ceases or nearly ceases to be acid, or becomes
alkaline ; when it contains mucus, or blood
globules, or albumen ; and when the patient
complains of pain or difficulty in voiding it, or
of pain or of tenderness on firm pressure of the
lumbar region, then disease of the kidneys may
be inferred ; and this inference will be the more
likely to be correct, if suppression or retention
of urine follow its alkaline character, and if so-
por and the more malignant symptoms become
more fully pronounced than previously.

54. After death from this consecutive disease,
or complication, both kidneys are found con-
gested or inflamed, but one is often more af-
fected than the other. They are always more
vascular, redder, and larger than natural. At
the surface and in the vascular structure, nu-
merous red points, intermingled with purulent
specks, are sometimes observed ; and the sub-

stance of the organ is of a deeper or darker hue
than usual, and softened in parts, or torn with
greater facility.

55. b. Consecutive nephritis often proceeds
from the absorption of purulent, or sanious, or
other morbid matters into the circulation. When
these matters pass into the blood, and more
especially when they are imbibed by the veins,
they contaminate this fluid, and the kidneys,
being the most active organs in eliminating
or excreting them from the system, are espe-
cially exposed to their injurious influence.
Hence asthenic nephritis often occurs in the
course of phlebitis, especially of uterine and
traumatic phlebitis, of the more acute forms of
tubercular consumption, of diffusive inflammations
of the cellular substance, and of diffusive abscess-
es, and after the rapid absorption of purulent
matter from the more chronic abscesses, espe-
cially from abscesses of the liver. In these cases,
various changes in the urine have been ob-
served. It has been generally alkaline, often
puriform, or nuico-puriform, thick, scanty, and
ultimately suppressed ; a morbid state of the
perspiration, adynamic fever, sopor, and coma,
with other typhoid and malignant symptoms,
appearing towards the close of life. In some
cases, a large quantity of pus, with some mu-
cus, is voided in the urine, shortly before the
affection of the kidneys supervenes ; but as it
becomes fully developed, so pain in the loins,
scanty, painful, and frequent micturition, with
the other symptoms of nephritis, are observed,
and precede the sopor and other typhoid symp-
toms, which are llie consequence chiefly of the
partial or total suppression of urine caused by
the consecutive nephritis. On dissection the
kidneys generally are found containing, in their
vascular and tubular structure, small collec-
tions of pus ; the structure immediately sur-
rounding these being softened, of a dark or
brownish hue, or paler, especially in patches,
and infiltrated with purulent matter. Occa-
sionally the tubular structure seems filled with
pus, and, in rarer instances, the renal veins
have been found inflamed.

56. d. Nephritis is often consequent upon the
eruptive fevers, more particularly upon scarlati-
na and smallpox. Its connexion with scarlatina
is of two kinds : 1st. It may appear in the course
of this fever ; and, 2d. It may not take place
until the fever has subsided, or until the ad-
vanced progress of convalescence from it. — (a)
When it occurs in the course of scarlatina, it
generally assumes very nearly the same fea-
tures as have been noticed in connexion with
typhoid fevers {() 7), and is extremely acute, the
urine being either suppressed or very scanty,
dark-coloured, bloody, or abounding in blood-
globules, albuminous, and passed frequently, in
drops merely, or in very small quantity and
with much pain. These attacks of nephritis are
either consequent upon a premature disappear-
ance of the eruption, or on an imperfectly de-
veloped state of it ; or it complicates the more
malignant states of scarlatina, and causes its
rapid termination in coma, &c. — {b) Where
nephritis appears during convalescence from
scarlet fever, it is more frequently of that par-
ticular kind which has been called albuminous
nephritis, or granular degeneration of the kid-
neys, and which I have viewed, since it was
first described by Dr. Bright, as a form of in

732

KIDNEYS — Inflammation of the — Consequences of.

flammation of these organs ; and as such it has
also been recently considered by M. Rayer.
When tliis state of disease is discussed, then its
connexion with scarlatina will be fully noticed.

57. (c) Asthenic nephritis also occurs during
smallpox, particularly its confluent and malig-
nant forms. In these cases the urine is very
scanty, alkaline, muco-puriform, or bloody, and
sometimes nearly black ; or it is altogether
suppressed. When this complication of small-
pox takes place, all the characters of the dis-
ease assume an aggravated or more malignant
character, coma and other typhoid symptoms
supervening. After death the kidneys are found
congested, ecchymosed, partially softened, of a
dark hue, and, in rare instances, infiltrated
with purulent matter.

58. e. Nephritis is often consecutive of para-
plegia ; and the influence of this state of palsy
in causing it is remarkable, whether the para-
plegia proceed from injuries or from diseases
of the spine or spinal chord. Nephritis may
also be consequent upon coma, especially in low
fevers, as above mentioned ; while in these
maladies, it more commonly produces or aggra-
vates this and other adynamic symptoms than
is supposed. Wlien nephritis appears in these
cases, it usually proceeds from retention of
urine, and the changes caused by this reten-
tion ; for it rarely takes place when accumula-
tions of urine are prevented. Probably, how-
ever, the loss of that portion of nervous power
supplied to the urinary organs by the spinal
chord has some influence in predisposing to in-
flammation of the kidneys ; and in imparting
an asthenic character to the disease, which, in
these circumstances, is attended not only by
retention of the secretion, but also by a very
alkaline, offensive, or ammoniacal state of it,
indicating the existence of disease of the blad-
der. Indeed, the alkaline, or ammoniacal, or
offensive odour of the urine in these cases, ari-
ses from the partial decomposition of the mu-
cous and other animal matters in it, while the
urine is retained in the pelvis of the kidney and
in the bladder. In these cases the structural
changes in the kidneys are nearly the same as
are met with after other consecutive inflamma-
tions of these organs, as already described.

59. /. Nephritis is often consecutive of prolong-
ed disease seated in the urinary bladder, or in
the prostate gland, or urethra. The frequent
and continued irritation of the urinary bladder
from inflammatory action of its mucous mem-
branes or of its mucous follicles, may occasion
congestion or inflammatory action of the kid-
neys, owing to the intimate connexion depend-
ing on function, and nervous communication.
Disease of the prostate gland, when of long du-
ration, or when it interrupts the discharge of
urine, is also apt to be followed by inflammation
of the kidneys, either with or without calculous
formations or gravel, these latter more frequent-
ly occurring in the gouty diathesis in connexion
with the prostatic disease. The pressure, also,
of stone in the bladder, by the irritation it oc-
casions in this viscus, and in the neck of the
organ and prostate, in connexion with the in-
terruptions it produces to the free discharge of
urine, often gives rise to inflammation of the
substance, as well as of the pelvis of the kid-
ney. In some of these diseases, the morbid
action seems to extend from the bladder along

the ureters to the kidney, as shown by the in-
flammatory action and its consequences ob-
served in one or both these ducts. Strictures
of the urethra, more especially where they pro-
duce retention of urine, are not infrequently
followed by acute or chronic nephritis. As re-
spects all circumstances, in which the disease
appears consecutively of disorder or structural
change of some other portion of the urinary
passages, it should be recollected that it is oft-
en chronic, sub-acute, slow, and insidious in
its progress ; that it requires close and careful
examination of the physiological symptoms,
and of the appearances and states of the urine,
to detect it ; and that its progress, as well as
its accession, is often masked by the symptoms
referred to the bladder, urethra, and perinaeum,
where they are most severely felt, as well as
by those attending the excretion of urine.
When nephritis is thus superinduced, its indi-
cations are to be found chiefly in connexion
with the seats of primary disorder, with the
powers of retaining the urine, with the frequen-
cy of passing it and the quantity passed, with
appearances and characters, and with its par-
tial or total suppression or retention.

60. iii. Of the influence of Inflammation
OF THE Substance of the Kidneys in produ-
cing OTHER Maladies. — This subject was im-
perfectly noticed, until Dr. Bright directed at-
tention to it in his researches in the granular
degeneration of these organs. The consequen-
ces which arise from this particular state of
disease will be stated hereafter. I shall confine
myself chiefly at this place to the consideration
of those which more immediately proceed from
the states of nephritis already brought under
consideration. It must be manifest that, where
inflammation attacks those structures which
are more especially concerned in the perform-
ance of the functions of the organ, the dis-
charge of these functions must be remarkably
disturbed. It is well known that, like other
glands, when the kidneys become inflamed,
they experience a remarkable impairment of
their functions. The membranes which sur-
round them and support them have the effect
of compressing them, especially when their
vessels are injected, congested, and inflamed,
thereby increasing their incapability, arising
from the inflannnatory state, of performing
their usual offices. The deposition, also, of
coagulable lymph, either in considerable patch-
es, or as an infiltration of the textures, farther
increases the pressure on the vascular and tu-
bular structures, and otherwise interrupts the
eliminating action of these organs. Whether,
however, impairment, or interruption, or sup-
pression of the functions of the kidneys be thus
or otherwise produced, there can be no doubt
of either the one or the other of these being
the consequence of developed inflammation of
tlie proper structures of these organs. Owing
to this change — to this interruption — the fluid
and saline matters requiring elimination from
the blood accumulate in it, and the vascular
system experiences a state of excrementitial
plethora, giving rise to impairment of vital en-
ergy, to congestions of other viscera, and to
effusions into shut cavities and cellular parts.
During the earlier stages of this vascular dis-
order, and before the blood becomes so impure
I and so watery as to overpower the tone and

KIDNEYS — Inflammation of the — Compucations of.

733

reactive energy of the vessels, and hence to
occasion congestion and loss of function of vi-
tal organs, a vicarious elimination of a portion
of the injurious materials accumulated in the
blood takes place by means of the skin and di-
gestive mucous surface, and in the form of
aqueous vapour from the surface of the bronchi
and air cells. At last, however, if the functions
of the inflamed kidneys are not restored, the
brain becomes congested or oppressed, and se-
rum is effused in the ventricles and between the
membranes. Hence the sopor and coma which
occur in the last state of unfavourable cases of
nephritis, and which supervene the more rap-
idly the more abundant and the more impure
the blood has been previously to the occurrence
of nephritis, as in the consecutive forms of the
disease just considered.

61. Even when a vicarious action is exerted
by the skin and mucous surfaces during inflam-
mation of the kidneys, yet these are incapable
of evacuating several or all of the elements or
materials requiring excretion from the blood,
and of combining them into those forms which
facilitate their discharge. The blood, there-
fore, must become, not merely loaded with
these materials, but farther changed, and even
rendered morbid or noxious by the influence
they exert upon the ha;matozine or principal
constituents of this fluid. Hence a state of
actual cachexia, of a most acute and malignant
nature, particularly in respect of its conse-
quences, is developed, the soft solids are ulti-
mately universally contaminated, and the body
experiences a rapid dissolution as soon as life
departs. During the progress of these chan-
ges in the blood, produced by the accumulation
in it of aqueous and effcete matters, various lo-
cal diseases may appear as consequences of
this excrcmentitial plethora, and contribute to
hasten a fatal result, or concur with others in
producing it ; or these consecutive malaxlies
may subside, if they be not severe, upon the
removal of the inflammation, and restoration of
the functions of the kidneys. Thus, diseases
of the digestive organs, particularly of the liver,
asthenic injlamination of the lungs, of the brain,
of the endocardium, and of the veins or arteries,
and dropsical effusions, may appear as results
of the action of the impure and morbid blood
on these organs. Dropsy, however, unless the
more acute states of it and sudden effusions of
serum, does not appear as a consequence so
frequently of the inflammations of the kidney
already considered, as of the more chronic and
peculiar form of disease first described by Dr.
Bright.

62. Various other important consequences
follow nephritis, and arise rather from the inti-
mate connexion subsisting between the kidneys
and the parts consecutively affected, through
the medium of nervous association and rela-
tions, continuity of surface, and intimate con-
sent and connexion of function. Many other
diseases of the urinary and sexual organs pro-
ceed from a primary disorder of the kidney,
more especially when such disorder is connect-
ed with the formation of gravelly and calculous
substances, and with inflammatory irritation of
the calices and pelvis of the organ ; but to these
a stricter reference will be made in the sequel.
As to the part performed by slight or partial
inflammatory action in the substance of the or-

gan, in giving rise to the formation of gravel
and calculi in the kidney, it is difficult to decide.
It is not improbable that it may favour these
deposites by obstructing the free passage of the
urine along the tubuli ; but there is much more
reason to infer that these deposites take place,
independently of pre-existing inflammatory ac-
tion, from the superabundance in the blood of
the elements or materials constituting them ;
and that when inflammation does occur, it is
rather a consequence than a cause of their
formation — that they proceed, in the first place,
from impaired power of the digestive functions,
in connexion with an excessive supply of the
articles of food abounding in the chief elements
of which they consist, and consecutively of im-
paired action of the kidneys, probably some-
times in connexion with partial congestions or
inflammations.

63. iv. Complications of Nephritis. — It is
obvious, even from what has already been ad-
vanced, that inflammations of the vascular and
tubular structures of the kidneys will both su-
pervene in the course of other maladies, being
thus consecutive, and give rise, when it is pri-
mary, to various important changes in the econ-
omy, both of a local and of a constitutional
kind. Owing to these circumstances, nephritis
will often present itself in practice as an asso-
dated or complicated malady — most frequently,
1st. With inflammation of the mucous mem-
brane lining the calices and pelves of the kid-
neys ; 2d. With gravel or calculi in the sub-
stance or pelvis of the organ ; 3d. With inflam-
mation of a portion, or of most of the investing
membranes ; 4th. With disease of the ureters ;
5th. With disease of the bladder and prostate
gland ; 6th. With stone in the urinary bladder ;
7th. With stricture in the urethra ; and, 8th.
With any two or more of these. As already
shown, the disease may be farther complicated
with one or other of the diseases, upon which
it occasionally supervenes, or which it sori>e-
times produces or develops. It is obvious
that these associations of nephritis cannot re-
ceive a more particular notice at this place.
To several of them attention will be paid here-
after ; and others of theia are fully treated of
in the articles Urine, Urinakv Bladder, and
Urinary Calculi.

64. V. Prognosis. — The prognosis entirely
depends upon the progress that nephritis has
made, upon the nature of the predisposing and
exciting causes, upon its seventy, upon the age
of the patient, and upon the circumstances of
its being a primary and uncomplicated malady, or
consecutive of, or complicated with some other
disease, either of the urinary organs or of some
other viscus. The simple states of nephritis,
particularly when occasioned by cold and hu-
midity, or by turpentine or cantharides, gener-
ally yield to judicious treatment ; but when the
disease is consequent upon other affections of
the urinary organs, or upon operations on any
of these organs, or when it occurs in aged per-
sons, or when it is so severe as to be attended
by suppression of urine, or by incontinence of
it, the prognosis should be unfavourable, or, at
least, be given with caution and reservation.
The prognosis ought, also, to be extremely
unfavourable, when the disease occurs in the
course of low, adynamic, and exanthematous
fevers, or when it is productive of sopor or

T34

KIDNEYS — Inflammation of the — Treatment.

coma, or wnen any of the more important chan-
ges, either in the blood or in other organs,
which it has been shown occasionally to cause,
is unequivocally manifested. Tiie occurrence
of retention, or of suppression of urine in aged
persons, who have been the subject of inconti-
nence of it, or of the more chronic symptoms
of urinary disease, or the supervention of the
acute attack, upon a slight or chronic state of
the malady, is always most dangerous. In
every instance, when the symptoms indicating
the accession or the presence of suppuration,
abscess, or of any other unfavourable conse-
quence of nephritis, are manifested, or even
when the disease has not yielded to a judicious
treatment within the period assigned to the
acute form of tlie malady ; when the urine be-
comes alkaline, offensive, and purulent, as well
as scanty, and the perspirations are urinous and
copious, the constitutional symptoms indicating
depression of the powers of life, obscuration or
oppression of the cerebral functions, and con-
tamination of the circulating fluids ; and when
a severe attack of nephritis occurs in the ad-
vanced progress of disease of some other organ,
or of low or exanthematous fevers, then a most
unfavourable prognosis of the result should be
given.

65. When disease, also, of the bladder super-
venes on a chronic affection of the kidney, ow-
ing to the morbid state of the urine ; and more
especially if suppuration occur about the neck
of the bladder, in consequence of irritation, in-
flammation, or other lesion of the kidney, a very
dangerous state of disease is present, more par-
ticularly when it occurs in aged persons, or in
those who have been subject previously to dis-
order of the digestive or urinary organs. In
these cases, the disease of the one organ reacts
upon the other, and thus both are aggravated
to a most dangerous extent.

66. vi. Treatment. — The treatment of neph-
ritis is subordinate to the causes, particular
form, complication, and state of the disease, to
the progress it has made, and to the age and con-
stitution and previous ailments of the patient.

67. A. Treatment of primary and simple Neph-
ritis. — (a) When the disease proceeds from a
concussion, sudden jerk, contusion, injury, or
wound, early and even repeated blood-letting
ought to be then especially prescribed, and the
patient should be restricted to an antiphlogistic
regimen ; diluents and demulcents being allowed
in small or m.oderate quantity. Of these, lin-
seed tea, barley water, the mucilages, the usual
emulsions, &c., are the most appropriate. An-
odyne or opiate fomentations or poultices may be
placed upon the loins ; and the patient may
iiave recourse to a tepid, emollient, or slightly
warm bath, on the following day. If the pain
and other symptoms continue notwithstanding
this treatment, or if they be only partially re-
moved, or if symptomatic fever is still consid-
erable, more blood should be taken away ; and
it may be taken by cupping or by leeches, the
former being the preferable mode ; but the
quantity should be prescribed without reserve,
for too copious vascular depiction is less inju-
rious in tliis disease than in most others, and
much less so than a too sparing recourse to
this measure. The smallne.ss or contraction
of the pulse should not deter from copious blood-
letting, especially if the local and symptomatic

pains are severe, and if retching or vomiting
is frequent. In these cases, the pulse will be-
come fuller and more developed by depletion.

68. (A) M. Raver remarks, that, if the in-
flammation is caused by a wound of the kid-
neys, and the fever has been subdued, and the
pain is inconsiderable, and if the discharge of
some pus in the urine indicate the supervention
of suppuration, blood-letting should be abstain-
ed from, and a severe regimen and regular
dressings of the wound prescribed. If the sup-
puration is prolonged, the diet ought to be more
generous, as a certain degree of power is fa-
vourable to recovery ; while too great severity
of regimen may retard recovery, and is only
applicable when the injury or wound has ex-
tended to the peritoneum, or has comphcated
the nephritis with enteritis or peritonitis.

69. (c) When nephritis is caused by canthar-
ides, by turpentine, by iodine, or by acrid diu-
retics, in too large doses, or loo long employed,
and the disease is slight, a moderate blood-let-
ting, demulcents, and tepid baths soon remove
the disease. If the symptoms, however, per-
sist, these means should be carried still farther,
according to the circumstances of the case.
Camphor has been recommended when the dis-
ease has been caused by canlharides ; but it
should not supersede blood-letting. It is an
excellent adjuvant of other means, particularly
when conjoined with oleaginous, mucilaginous,
or demulcent substances, and given in small or
moderate doses.

70. {d) Nephritis, caused chiefly by cold and
humidity, in strong, young, and plethoric per-
sons, requires an active recourse to general
and local blood-letting, and the antiphlogistic
and emollient means above advised. If the
symptoms are merely abated, cupping, or a
repetition of it, over the loins, must be prescri-
bed, and demulcents taken by the mouth and
administered in enemata. For nephritis from
this cause, tepid or gently warm baths, and
sudorifics, conjoined with emulsions and ano-
dynes, are especially indicated. In this, as
well as in other states of the disease, the how-
els should be kept in an open state ; and for
this purpose, castor oil, or sweet oil, or both,
may be prescribed and administered in demul-
cent vehicles. In some cases, after the dis-
ease has been even for some days apparently
subdued, chills or rigours return, followed by
pain in the loins, febrile reaction, and other
symptoms of a reciirrence of inflammation.
When this is observed, a large blood-letting
ought to be prescribed, unless the patient be
far advanced in life ; and, in this case, cupping
on the loins, and the abstraction of eight, ten,
or twelve ounces of blood may be sufiicient.
When the symptoms lead to the inference that
the investing membranes are chiefly affected,
then the depletions should be copious, and cal-
omel, with antimonials, or with other diapho-
retics, ought to be freely prescribed.

71. (e) Sub-acute nephritis requires a similar
treatment to that above advised ; but vascular
depictions need not, in general, be carried so
far as in the acute form. One large cupping
over the loins may be sufficient ; but it will
often be necessary to repeat it ; and, although
this state of nephritis may not be so severe, it
may be more obstinate than that already con-
sidered ; and when both kidneys are afTccted,

KIDNEYS— Inplammation of the — Treatment.

r35

the treatment should be more energetic. The
other means just mentioned are also appropri-
ate in this state of the disease ; or the diet and
regimen should not be materially different from
that directed lor the acute form. The use of
animal food, and of fermented and spirituous
liquors, ought to be especially avoided.

73. (/) Chronic neplirtlis is often removed
with much more difficulty than the acute at-
tack ; for, as it often has proceeded far before
it has come under treatment, and is frequently
caused and perpetuated by calculi in the kid-
ney, the most judicious means may produce
only temporary benefit. It is generally render-
ed more obstinate by the continuance of the
habits and modes of living usually pursued by
the patient during the treatment, notwithstand-
ing the injunctions of the physician to the con-
trary. Generally one or two cuppings on the
loins, with the antiphlogistic regimen, aided by
a strict avoidance of animal food and of exci-
ting beverages, will remove the disease, or
very remarkably ameliorate it, even when cal-
culi have produced it ; but farther measures
are often necessary, particularly when it pro-
ceeds from this cause. Having, in such cases,
carried vascular depletions and other antiphlo-
gistic means as far as may seem prudent, some
permanent external derivative will be requisite,
in order to supersede the irritation still exist-
ing in the kidneys. Issues or seloiis in the
loins, or in the insides of the thighs, kept free-
ly discharging for a considerable time, and the
internal use of the preparations of the diosma,
or of the uva ursi, with demulcents, with alka-
lies, or with acids, especially the muriatic or
nitro-muriatic, according to the state of the
urine, which ought always to be carefully and
even chemically examined, are often the most
beneficial means which can then be advised,
particularly if they be aided by a suitable diet
and regimen.

73. If either the stib-acute or chronic states of
the disease suddenly assume an acute or hyper-
acute form (^ 14-17) — a circumstance by no
means uncommon — the means advised for acute
nephritis (^ 67-70) ought to be most promptly
and energetically employed.

74. B. The treatment of the modified and con-
secutive nephritis (>J 46, et seq.) necessarily va-
ries with the diathesis of the patient, and with
the disorders or maladies occasioning it. — a.
Nephritis in. the gouty diathesis (() 47) is gener-
ally removed by cupping on the loins, and ab-
stracting blood, according to the age, strength,
and habit of body of the patient ; by derivatives
applied to the lower extremities, and by dilu-
ents and demulcents containing some one of
the alkalies or alkaline earths, and anodynes.
Magnesia or soda, with colchicum, or these
with cathartics or purgatives, a vegetable or
bland diet, attention to the digestive functions,
and avoidance of heating and exciting ingesta,
are also of great service.

75. In robust and plethoric persons, general
blood-letting is often necessary at the com-
mencement of the treatment ; and when the
inflammatory action is perpetuated by the irri-
tation of calculi or of gravelly matter, local de-
pletion should be repeated, and demulcents,
combined as above, should be assiduously em-
ployed. When the disease passes into a chron-
ic form, the treatment recommended for chronic

nephritis (^ 72) ought to be prescribed, and the
infusion of I'arcira Brava, or of the diosma cre-
nata [or the uva ursi], aided by the alkaline min-
eral waters and external rubefacients, freely
employed. When gravelly or crystallized sub-
stances are voided, or when their presence in
the tuhuli uriniferi is inferred, these remedies
and the means already advised should be per-
sisted in for a considerable time. This form
of nephritis is not readily removed when it as-
sumes a chronic form in old, gouty subjects, or
when it has been neglected m an early stage,
or in previous attacks. In these cases more
especially, much attention is requisite to diet
and regimen, and to the state of the evacua-
tions. The biliary secretions should be promo-
ted, and the bowels kept freely open by sto-
machic purgatives and moderate doses of the
milder preparations of colchicum. When the
stomach is irritable and flatulent, or when nau-
sea and vomiting occurs, creasote, with small
doses of opium, and with magnesia or some al-
kaline preparation, in demulcent and aromatic
mixtures, is often extremely serviceable.

76. b. Rheumatic nephritis {^ 50) has been
shown above to be so obscure, in many cases,
as to render it difficult to determine how far
the kidneys are really affected. When, how-
ever, the symptoms particularized above are
present, there can be little doubt of those or-
gans being acutely, or sub-acutely, or chronically
inflamed ; and still less of the propriety of hav-
ing recourse to cupping on the loins, to demul-
cents and diluents, to the infusion of diosma,
or of Pareira, or to the decoctions of marsh
mallows, of guaiacum, of senega, &,c., with al-
kalies, with colchicum, &,c. When the attack
is severe, and the patient is strong or plethoric,
general blood-letting should precede the cup-
ping on the loins, and external derivatives, par-
ticularly to parts previously the seat of rheu-
matism, ought to be applied. The turpentine
embrocation may also be prescribed to the loins,
and morbid secretions and fa;cal accumulations
duly evacuated.

77. If any dread of the occurrence of endo-
carditis or pericarditis be reasonably entertained,
camphor may be given with mercurials and opi-
um, or the decoction of senega, or of guaiacum,
[or colchiciim], may be taken with alkalies, an-
odynes, &c., and external derivation by means
of open blisters, issues, or setons, or by rubefa-
cients, assiduously employed.

78. c. For secondary or consecutive nephritis
{ij 52), the treatment must depend chiefly upon
the states of vital power, of vascular action,
and of the circulating fluids. In proportion as
the vital energy is depressed or sunk, and the
blood contaminated, and as the disease con-
sequently assumes an asthenic character, so
should vascular depletion, even locally, be re-
sorted to with caution, or be altogether with-
held. In these cases, the capillary circulation
of the kidneys is interrupted, the vessels are
congested and incapable of reacting upon their
contents, and the secreting function is impeded
or altogether suppressed. In these circumstan-
ces, although local depletion, especially cupping
on the loins, may partially unload the weaken-
ed and congested vessels, yet it cannot restore
the nervous or vital power of the kidneys so as
to enable them to perform their functions. We
often find, in the more severe of tl>ese consec-

736

KIDNEYS — Cachectic Inflammation op the.

utive states of nephritis, the secretion of urine
altogether suppressed, and both organs atlected,
particularly when occurring in the course of
continued or eruptive fevers, or after the ab-
sorption of morbid secretions into the blood, or
after injuries of the spine. When this is the
case, but little benefit results from cupping on
the loins or from other modes of vascular de-
pletion, unless means be used at the same time
to rouse the action of these organs. The choice
and application of these means are, however,
among the most difficult things in practical
medicine. Indeed, the practice, in these cir-
cumstances, can only be experimental, endeav-
ouring, however, to suit the remedies to the
pathological states inferred to exist at the time
of prescribing them, and to the sensible quali-
ties of the urine. In most of these cases, es-
pecially when the disease is consecutive of
paraplegia {^ 58) or coma, the urine is more or
less alkaline, and is probably secreted in this
state, although the partial decomposition or
change of the mucus secreted by the urinary
mucous passages may farther increase it. The
mineral acids, particularly the hydrochloric, con-
joined with hydrochloric ether, and given in ton-
ic, antiseptic, and restorative vehicles, seem to
be the most appropriate medicines to these ca-
ses. Camphor may also be tried in conjunction
with nitre or the chlorate of potash ; and em-
brocations containing this substance and the
spirits of turpentine may be applied to the loins ;
or, this latter may also be given internally, in
small doses, with the view of exciting the ner-
vous energy of the kidneys and the action of
the congested vessels. When, however, the
patient is plethoric or robust, and vascular ac-
tion and tone are not remarkably reduced, the
abstraction of blood from the loins by cupping
should precede the use of the above remedies,
and should be carried as far as the states of
vital power and of the circulation may permit.
When vascular depletion cannot be farther pre-
scribed, dry cupping on the loins may still be
had recourse to.

79. For the form of asthenic nephritis Avhich
sometimes occurs in the course of low fevers,
or in consequence of the absorption of morbid
secretions into the blood {(^ 53-57), the reme-
dies now recommended may be tried, particu-
larly dry cupping, camphor, the chlorate of
potash, the chlorides, hydrochloric acid and
ether, nitre and the spirits of nitric ether,
stimulant and rubefacient embrocations and
blisters on the loins, or other derivatives ; but
little dependance can be placed on medicines
when this stale of the disease is attended by a
total suppression of the urine, as observed in
the worst cases of it, and more especially if
coma or convulsions have taken place.
II. Cachectic Nephritis. — Syn. Granular dis-
ease of the kidneys ; Renal disease, accompa-
nied with secretion of albuminous urijie, Bright.
Diseased state of the kidneys connected icith al-
buminous urine, J. Gregory. Granular degen-
eration of the kidneys, Christison. Albumina-
ria. Martin-Solon, Willis. Morhis Brightii,
Maladie dc Bright, Auct. var. Nephrite albu-
mineuse, Rayer. Nephritis cacheclica, N. so-
ciata. Associated Nephritis, Nephritis from con-
stitutional vice. Nephritis from a morbid state
of the blood, Inflammation of the Malpighian
corpuscles, Author.

80. Defin. — Uneasiness or pain in (he loint,
pallid or cachectic appearance of the countenance,
disorder of the digestive futictrons, more frequent
calls to void urine than natural, this fluid contain-
ing albumen, and being of less specific gravity
than usual, owing to a diminution of its salts and
of urea, dropsy or some visceral disease appearing
in connexion with the morbid state of the urine.

81. Patuol. Charact. — A morbid state of the
blood, characterized chicfiy by the presence of urea
and deficiency of albumen, and of hcematostne, in
connexion icith lesion of the circulation, minute
glandular bodies, and [altered'^ structure of the kid-
neys, tvith various organic changes in other viscera,
and generally with serous effusion into the cellular
tissue and shut cavities.

82. A general idea may be formed from the
above definition of the view I intend to take of
this disease, which has attracted much atten-
tion since it was discovered by Dr. Bright, yet
not more attention than its real importance
deserves. Although medical writers of high
authority have fully investigated this malady,
still certain topics connected with both its pa-
thology and its treatment, the particular tissue
of the kidneys primarily affected in it, require
farther elucidation. Indeed, the connexions
subsisting between it and morbid states of the
blood, and between it and many visceral mala-
dies, still require a full exposition, and to these
topics farther notice will be directed in the se-
quel.

83. i. Description. — Cachectic nephritis as-
sumes two forms, the Acute and the Chronic,
the one gradually passing into the other, al-
though sometimes sufficiently distinct, in re-
spect of the course of individual cases, to war-
rant this distinction, which has been made by
both Dr. Christison and M. Raver. The acute
form, is frequently /eijj/c, or attended by mark-
ed vascular reaction ; the chronic is non-febrile,
and although the pulse may be accelerated, it
is usually compressible or soft, or even small
and weak. The symptoms may be acute at the
commencement, but pass into those of the
chronic in the course of the disease ; and after
having thus assumed the chronic state, exacer-
bations of febrile states may occasionally take
place ; but in either form, especially in the
chronic, it may present a variety of aspects —
numerous modifications — according to the pre-
vious circumstances, disorders, or predisposi-
ti